Doctors from the Nursing Perspective

I’ve worked with some wonderful doctors in my career. I’ve worked with some horrendous doctors in my career. This post is not about horrible doctors, but to throw some perspective in there, I’ve had bloody scaples thrown at me from across a surgical suite. 

I’d always heard the ER was a crazy place to work, and it is. What I love about it though, is that my doctors are sitting next to me. Well, almost so. They have a small alcove in the center of the nurses’ station, but it’s not full walls, more like grids, so everyone can hear and almost see what’s going on everywhere in the unit, but hides the doctors from inquisitive patients and family members. The benefit? They see and hear everything their nurses say and do for the patients and I think it has changed their perspective on our field. 

Friday, as I ate my sandwich while charting, my doc asked for an update on my patient. “She’s ready to discharge, just waiting on the fluids to go in.” “Can we put her on a pressure bag?” (This is a bag around the fluids that is pumped up and all it does is literally put pressure on the fluid bag to make it go in the vein faster.) “Sure! Let me go grab it.” “Don’t worry; eat your lunch, I’ll do it.”

Jaw drop.

Last week I walked in to my patients room for the first time as the doctor and his scribe were walking out. “They’ll need a line and labs, a few swabs, and an EKG,” he said to me. “But I’ll be right back.” As I wheeled the EKG machine in the room, he returned with a warm blanket for the patient.

Jaw drop.

Things like this happen every day I work in this Emergency Department. It could be this department, in this hospital. I’ve worked on units where the medical director made a point to hire doctors who were true team players and respected the entire team. And I’ve worked on units which the opposite was true. It could be an ED thing in general, but I don’t have the experience in emergency work to tell that yet.

I recently read an article (https://www.uchealth.org/today/2017/03/14/a-morning-in-their-shoes/) in which a medical residency program required the newly graduated doctors to follow a nurse for a shift. I genuinely think this is a must for hospitals, and for every part of the healthcare team. I would love to shadow a doctor for a day. I know I learned a ton as a circulator in the OR in that I was the one answering their pagers when they were scrubbed in to the field. The look of dismay when I read the page stating the patient’s potassium was 4. (Smack dab in the middle of normal.) The sheer number of patients doctors see and are charged with the care of each day is almost at a horrendous level. 

Our workflows are drastically different and to have a better understanding and empathy towards those differences can mean the difference in a good or bad patient outcome. Working together with respect of eachothers’ time and energy is critical. 

Heroin

Today I gave my patient alcohol wipes to take home with him. He’s a daily IV heroin addict and had the characteristic nodules across each arm from hitting up.

I told him he had to quit. But then I told him that I knew it wasn’t going to happen any time soon. So here’s what I made him promise instead: throw out all the use needles in his house and only use new ones from here on out, and always clean his skin before hitting the vein. 

Some battles will be won in a day. Other battles will not.

Perks of a Miserable Job

As some of you know, I’ve left travel nursing and gone permanent! Whaa??! Why would I do such a thing?? Experience. I want to be a flight nurse and after gaining the great ICU training and experiences travel nursing offered, I need ER experience as well. No ER in their right mind would take an agency nurse with no ER experience, so I went perm. Whew. Crazy ride. The ER is a totally different beast than the ICU or OR. They’re all crazy in their own way, but the past month of orientation has been to learn how to deal with the flow of the ER, the turn over, the balancing of three full-blown sepsis workup patients with a code stroke coming in just for giggles. Life has been crazy. And I’m bad at it. I’ll get better with time. I know that logically, but it’s been a while since I’ve been the newbie and it’s caused an amazing amount of stress and mental challenges. I don’t enjoy being bad at something, so jumping out of my comfort zone like this is, while great for me, painful.

That’s why, when my friend Freya RN sent me this list, it came at a perfect time for me. I love nursing. It was a great decision to change careers, and with all the pain, it’s still worth it. Enjoy.

 

1. I get to do cool shit – chest compressions, advocating for my patients, educating them about something that seems scary and isn’t.
2. Nurses have the best sense of humor, especially the peers you work with at the bedside. Who else is going to come help you clean up poop and silently laugh with you when the patient farts.
3. We have the BEST pranks at bedside. Think of the possibilities – urine specimen cups, chocolate candies, morgue carts.
4. If I get tired of working in the ICU, I can just as easily switch to ER, NICU, L&D, PACU, etc. without getting another degree.
5. I get to be there with my patient and their family for the highs and the lows.
6. I can name every crayon in the Crayola box for nurses – Upper GI bleed red, lower GI bleed maroon, coffee ground emesis, stool sample brown, etc.
7. I can provide comfort to my patients that no one else can, there’s something reassuring about a cool, calm and collected nurse taking care of you.
8. I get to hear the coolest diagnoses (such as, “Big Mac Attack”) and the weirdest stories as to how a patient got sick.
9. I get to work with so many other professions at the bedside and learn from them.
10. Every once in a while, you get a thank you from someone for doing a job that is many times thankless, and I hold those moments near and dear to my heart.

Babies Teaching Babies

Our first collaborative post! A dear friend of mine, who would like to remain anonymous as Freya, RN, contributed the below post. I’ll be posting another of hers tomorrow as well. Keep a look out!

I find it hard to organize my thoughts regarding this topic. It’s been the bane of my existence for the last year, and I’m running thin on my patience and my understanding at the moment.

I am by no means an experienced nurse. I’ve been a nurse in the ICU for four years and I’m getting tired of babies teaching babies. I was a new graduate in the ICU. I’ve been there. I should be more empathetic. The thing is, I was raised by nurses who had 5-20 years of experience in the ICU alone. I always had someone with more experience than I do to rely on. Someone who could help me with my critical thinking and decision-making process. Now, with my few measly years of experience, I’m a top dog at many of the hospitals I’ve worked at.

I have worked in situations now where I am one of the most experienced nurses on a busy unit. These new nurses are so intimidated by working in the ICU that some of them don’t ask questions. If they do ask questions, they feel more comfortable asking their peers and it becomes and issue of the blind leading the blind.

I’ve overheard some conversations that I’ve interjected myself into, just to be able to guide these nurses in the correct direction. Recently I heard a nurse of less than 6 months ask another nurse of only a year if she had to call the doctor back to clarify whether the doctor wanted a heparin drip with or without boluses (HUGE difference). The nurse she had asked said “I know what I would do, I’d just order it this way.” I couldn’t help myself (and probably looked like the biggest jackass in the world) – I walked over and I sad, “I would 100% call the doctor and clarify. It sucks that you didn’t think to ask the first time about the boluses, but really he should be putting in the orders anyways. Think of it this way, after paging and talking to him a second time because of this, you’ll never forget to do that again.”

I’ve heard some scary things out of these new nurses mouths, and I honestly believe it is because the person training them has only been out of nursing school for six months to a year. I’ve offered to train new graduates while in a permanent position and I’ve not had a student for the last five or so months while these babies are training babies. I believe it has been due to my complete honesty and my expectation that if you have a question for me, you’ve thought about the patient, the problem and have thought about what you would want to do. I do not give out answers for free, I train nurses to THINK. You cannot be an ICU nurse without thinking. 

 The scariest part of this whole thing is that management doesn’t seem to find an issue with nurses that have 6 month of experience, training new graduates in the ICU. There are always better nurses than others at any level of experience in the hospital, but I feel we aren’t setting up our new graduate nurses to succeed when the people training them have barely had time to be nurses themselves. The blame isn’t all on management and the higher ups though. The issue is that more and more bedside nurses don’t stay at the bedside. Bedside nursing is no longer a career – it’s a stepping stone. It’s a starting place for CRNA, NP and other advanced nursing careers. Many new graduates start out in the ICU with the plans of being a nurse practitioner by the end of 3 years. I can understand the appeal, a lot less physical labor, less time with the patients, more knowledge, and (what it’s ALL about) better pay.

The more these stepping stone nurses come into the work field, the more older nurses begin to leave the bedside. They leave because staffing becomes difficult and patient to nurse ratios become unsafe when turnover becomes so high. They leave because the people they work with are inexperienced and a danger to their patients. They leave because they can’t physically bear turning a 300 lb+ patient with only the assistance of one other person (and that is the only person they could find after ten minutes of searching.) To be honest, I LOVE bedside nursing, but I don’t blame these nurses. I’ve experienced the issues, I’ve heard the excuse of “It’s been worse before,” and I keep coming back. I’m not sure if that just makes me a glutton for punishment, a martyr, or more likely, a silly gal with a heart for helping others.