Wednesday, December 28, 2011

How has nursing changed since 1887?

Nurse Talk recently put up a link to an article in Scrubs magazine called, A list of rules from 1887, in which the nurse administration is offering up rules and advice for the nursing staff.  I couldn’t help but chuckle as times have definitely changed!  I would like to offer that I would most likely not be in good standing in that work facility as I frequent the beauty salon on a regular basis and consume wine!  (Such a hussy J)
On a more serious note I was intrigued by the other rules on the list. After a good laugh I really looked at the list. The rules were practical and straight forward.  Clean your patient’s room…washing the floors and dust.  While I’m glad that I do not have to do that myself I am very happy that housekeeping is around to clean my patient’s floors and dust their room to keep germs at bay and provide the feeling of calm.  The nurse was also responsible for the lighting in the patient’s room so she had to tend to the candle wicks, (how awful to practice with no electricity!!)
Getting to work on time is an important rule wouldn’t you say…as is keeping good notes on your patient’s condition, “for the doctor.” 
I thought it was rather interesting that the administration told the nurses to “put aside a good portion of their pay each week as to not become a burden in their older age.” I suppose they thought that as a nurse you had a duty to take care of yourself financially… I suppose they felt it irrelevant to tell the nurses to eat properly and get exercise and eat well, that was probably just a given back then whereas today …not so much!
Finally, if the nurse served her patients, the docs and the facility well for 5 years she may get a raise…Let’s hope that rule doesn’t come back!! 
I decided to think back on the list of rules I was taught 21 years ago…in 1991…  Present yourself to work on time and leave on time as to not cause the hospital financial grief.  Present yourself in a professional manner, clean white, pressed uniform and clean white shoes. (if not you would be sent home to change.)  No bear legs, wear white hose.  Name badge is to be clean and have all your pins of accomplishment on it to provide the patient with a sense of calm.  No swearing.  Clean fingernails and minimal makeup.  Hair was to be kept in a style that would not intrude on your work or fall into the patient’s field of care. Stay current on nursing research and standards.  Be respectful to the doctor at all times, get up and give him your chair, offer to be of assistance and be sure to surrender the chart to him even if your charting was not finished.  You all get the idea…
What is nursing like today?  There are many improvements in terms of nursing rules, our responsibilities have exploded and allowed us to be responsible for every aspect of our patient’s care…but I am not sure that the nurse has improved…now don’t start yelling and swearing here.  I, like all of you, am happy that the word nurse does not mean maid, doctor’s whipping post, slave or housekeeper …but what does the word nurse mean, how are we expected to act now.  It seems to me that we nurses have become an entitled, grumpy, challenging group of people.  We do not like rules imposed upon us and we sure as hell want a raise every year despite our standing.  I am not trying to be a negative nelly here but let us not forget that we became a nurse to “take care of patient’s” 
This has been a very good reminder to me as I hope it has to you.  A nurse is someone who takes care of patients, their every need… (You know what I mean).  Let us do this in a professional manner, with a smile and a caring heart.  I am not saying for us to move back into the dark ages and let people harm us, swear at us or degrade us…but if we want our profession to continue to be the most trusted and highly respected, WE must also respect it and what it stands for.  Let us take pride in our title…NURSE.

Tuesday, December 20, 2011

A heavy heart.

I cannot get into specifics but I have a question for all of you fellow nurses.  What do you do when you have a patient that is young, experiencing end stage metastatic cancer and they do not know it.  The oncologist has not given them the realistic and total picture of their disease process NOR have they been given the tools to deal with the fact that the treatment they are undergoing IS NOT WORKING.
I worked in hospice many years ago and I had a bitter taste in my mouth then, as I do now, when the oncologist continues to throw one chemo/radiation therapy after another at a person who is just getting worse… and then they die in the midst of treatment and everyone around them, including often times their children and spouse are left with the thoughts of “but they were getting better….the doctor said the treatment was hopeful.”  
While I was a nurse in the hospice world I had a voice and I could council my patients as they directed me to…I could also have a voice with the team that was treating the patient.  I often feel left out in the wind while working these people in the ER.  My role as the ER nurse is to deal with the situational issues that arise with this patient population, not to have a role in their treatment plan.  I feel like I’m standing in the corner of the room with duct tape on my mouth and my hands tied behind my back…watching from afar as this confused, sick and often times dying patient enters our doors and needs help…and the most sickening part is they and their families are so unaware of what is truly happening. 
As a nurse we have the obligation to provide the total and holistic range of care that each of our patients needs and deserves…I cannot help but wonder where the moral compass points on this issue for both nursing and with the medical professionals who treat these types of patients.  The “never give in and never say die” attitude with which many oncologists practice is all fine and good to encourage hope and strength in the patient population, but when is it okay to tell the patient the truth from the facts of their case… I know that it is a struggle of thought that when you tell the facts…the patient may lose the will to fight or may give up…but what if that patient and their family needs that information to stop the insanity and come together for some last weeks of time with saying goodbye?
Each person that we come in contact with has the right to be told the truth of their situation…and sometimes that truth is, “we have done all we can do and now we need to make you as comfortable as possible so you have some good weeks left to be with your family, free from treatment and free from pain, to have the strength and mind to say goodbye.  Fighting the fight is all well and good until the fight needs to be ended…ended in time to allow for time…
What is your experience?

Tuesday, December 13, 2011

Twas the night before Christmas and the nurse is at Work

Twas the night before Christmas and the nurse is at work
Many a creature is stirring, including a jerk.
All the IV’s are hung by their poles with care
In hopes that 7am would soon be there.
The patients are snuggled all safe in their beds
While drug induced dreams dance in their heads.
My fellow nurses and I who are no longer in caps
Are Just sitting down at the station to rap
When out of room seven arose such a clatter
I sprang from my seat to see what was the matter
Away to the bedside I flew in a flash
Where I grabbed the puke bucket from the cabinet stash
The light I turned on, in order to know
Exactly what the bucket contained and would show
When what to my wondering eyes should appear
But a disgusting recycled bucket of beer
Lifting my leg to hit the call bell with a kick
My fellow nurse came to assist quick as a lick
We changed him and flushed the bucket of shame
And he whistled and shouted “All hale the dames”
“They are the queens of the ER~…maybe one is a Vixen”
“Lets order some pizza! and we can call it a Mix in”
“We’ll sit on floor or lean on the wall”
“or maybe Ill just lie down in the hall”
We guided the poet who was on such a high
Back to his bed so sleep could apply
Within 5 seconds he was snoring anew
His monitor showing vitals not to warrant Code Blue
And then in a twinkling we heard something aloof
It was only the tech Ben, always being a goof.
As I let out a laugh and was turning around
He hit me with a spit ball and it fell to the ground
The patient in room seven was again up and on one foot
And this time his gown was all wet and stained with “soot”
A bundle of sheets flung over his back
He looked like street walker complete with a sack
His eyes how they twinkled, his mood was so merry
His cheeks were like roses, and his nose like a cherry
His droll little mouth was drawn up in a bow
And the beard on his chin was no longer white as snow
The spittle of puke held tight to his teeth
And the bed pan he held on his head like a wreath
He had a thin face but a big round belly
That now shook with a laugh like a bowl full of jelly
He was nothing like a plump jolly old elf
And we laughed when we saw him in spites of ourselves
A wink of eye and twist of his head
He turned around, showed us his butt…and went back to bed
He spoke not a word but flashed us a smirk
Even I had to say he was no longer a jerk
And putting his finger up inside his nose
Then giving a nod he declared, “this blows”
We moved back to our seats and sat down with a whistle
His room looked as if it was hit with a missle.
But all together we laughed and said, while keeping the patient in sight
Merry Christmas to all…and to all a good night.

Tuesday, December 6, 2011

Marriage, Love and Holistic Nursing.

My husband and I have been married for 27 years, and have been together for 29.  We were high school sweethearts. I love to think back on those days.  I was the cheerleader and he was the jock from a small town high school.  I used to sit in the middle of his truck seat while we were on dates, snuggled up close.  I couldn’t get enough of being near him!  Today it really is still like that for us… I know people will moan and groan at reading that, but by the grace of God it is true. 
I say this because I was witness to the sweetest and saddest thing today, and as a nurse it was my honor to be a part of it. 

I walked into the room of my newest patient, a 94 year old woman with increased confusion.  She was sent to the ER from her nursing home residence.  Her chart tells me that she has dementia and a long history of UTI's and resulting sepsis. 

"Good morning _____, I'm Bobbi and I will be your nurse today,"  I say as I enter the room, put the chart on the counter and move to the stretcher.  

She says nothing, and only watches me.  Her eyes are large and brown.  She seems to go long periods with blinking...but her eyes see me~ they are not vacant.  She has elegant white hair that is styled in a rather severe bun on top of her head, held in place with a gold scrunchy elastic.

"Your care givers are concerned that you may be sick, so they sent you to the ER for a check up...I need to do my assessment now if you don't mind."

Again, nothing but her eyes watching me.  No recognition of my words making sense.

As I undress her to look for any indication of infection (sores, wounds or skin breakdown) I continue to tell her what I'm doing and why.  I change her into a johnny, listen to her heart and lung sounds, give her warm blankets and place her on our vital sign monitor. I collect a fem-cath urine sample, draw blood while starting her IV and do an EKG.  

"I'm finished for now Mrs. _____.  I have to go and give this EKG to the doctor and then I will return in a few minutes.  Here is your call bell, this red button is the one to push if you need me."  

Just as I start to leave the room a very elderly man enters and introduces himself to me as “…….’s husband.” He is dressed in a navy blue sport coat over a black sweater, dark gray pants and a very dapper gray hat.  He walks hunched over with a cane for support.  His eye brows are very full and seem to move on their own as he spoke.  His accent sounds British.  I explained to him what I have done so far with his wife and what we would be looking for.  I pulled up a chair by the bed for him to sit.  He shook my hand and smiled.  His large arthritic hand is very cold. He moved to the bed and leaned over the rail and kissed his wife on the lips.  She smiled, but didn’t speak. He then took the chair I had offered but continued to hold his wife's hand through the stretcher rail.
“We have been married for 75 years.” He said.  

An ER tech stepped inside and took the EKG from me and winked.
“Congratulations, what is the secret to such a long marriage?” I inquire as I sit on the stool next to him. (I knew I had other patients but nothing was immediately pressing and I just felt compelled to sit and talk to this man.)
“Empathy for one another’s start in life, passion for the teenager you once were with each other and for the man and woman you grew into, pride in the other’s strengths and overlooking most weaknesses and Love ….Love for child of God that you married.” He answered while holding his wife’s wrinkled hand in his. 
I became a little teary as he shared this with me, as he was a little teary.  I told him of my husband and my children and that I felt so blessed.  He told me that God puts 2 people together to make them one, to make them stronger and to make them whole.  He told me that they had raised 4 children and 14 grandchildren and 10 great grandchildren, and that his wife loved him and their children fiercely and that, “it just kills them that she cannot communicate with them anymore.” 
I couldn’t talk, I wanted to cry.  He stood and once again kissed her lips.  She once again smiled but said nothing.  He then said to me, “she may not be able to communicate with words anymore but when I kiss her she still smiles at me the same way she always did….so I still kiss her on the lips as much as I can.”
I thanked him for sharing this with me…for allowing me a glimpse into their world.  He just smiled and tipped his hat.  The doctor came in, oblivious to our conversation and oblivious to the gift that I had just been given.  

Thursday, December 1, 2011

New grandbaby and old nursing lesson.

As I sit staring at my new grandson I cannot help but marvel at the art work of God.  This little man came into the world weighing 7.3 lbs. and was 20 inches long.  His fingers are long and strong.  He has big blue eyes and a pouty little mouth.  Black hair covers his crown and perfect little feet top off his long legs.  He is the perfect combination of his mother and father with a spakling of my son and husband.  What I marvel at the most is the instinctive moves he makes~  he turns his head naturally and starts rooting for food when he is hungry, he curls his little fingers around anything that touches his hand.  The wonder of his innate instinct to eat, to stop eating, to urinate and have a bowel movement is another reminder of how wonderful creation is. 
The other thing that I love to watch is the way he cries if hungry and immediately stops when food is provided.  The need for human contact is another area of wonder~  the way that holding him close and talking to him calms him instantly…. We humans need very few things to survive…we are strong and resilient~ but we all need food, clothing, contact and shelter to survive well.
In my first semester of nursing I recall learning this principle…that patients need those basic things as well to heal and to survive and to survive well.  The powerful tool of human contact is one we should all remember. The patient that is fed, given safe shelter and clothing, good medical care and medications will still NOT do well if there is no human caring involved…esp. if they have no caring family in the patient’s world.  The elderly patient that comes in from a nursing home, no family in the area, and in need of medical intervention does much better when the nurse takes the time to sit with them, give them a bath, a soft massage and doing all of this while gently talking to them.  NICU babies will not thrive, and in some cases die, without human contact…behavioral health children do much better while in our care in the ER if the nursing staff has the time to sit with them and talk with them…
I like this phase of my life and my nursing career that has me thinking back and learning lessons.  I like that I am in a place of my career that I have the skills and the job that at times gives me the chance to sit and bond with a patient~ giving them the human contact and caring that they need.  I thank God today for my healthy, beautiful grandson, my family and friends and my nursing career.  I thank God for the continued lessons that he places before me every day.