The Truth

nursing

When you think about nursing, what do you see? I would bet that you see the quintessential nurse in scrubs coming to see you in your hospital bed, scanning your bracelet, running through your name and birth date, and giving you pills while asking you if you need anything, then rushing to the other side of the room or out the door to see his/her next patient.

Am I right?

Don’t feel bad, that’s the reality of hospital nursing. A nurse usually has anywhere from 5-7 patients of varying acuities at a time. Not only that, but most floors are understaffed in both nurses aides and nurses, which makes a regular day on a hospital floor even more hectic for everyone involved. Not only that, but the acuity of patient’s has increased ten-fold. Patients now have multiple co-morbidities, dozens of medications, IVs, PICC lines, central lines, wounds, mental health issues, etc. On top of all this, most patients think that a nurse is there to serve them snacks and drinks while being cheery and focusing solely on them at all times. No one truly realizes the stress, the pace, and the heartbreak of a nurses job.

My last and only hospital nursing job was at a small-ish hospital in Upstate New York. I could reflect and say that we were pretty lucky – during day shift at least. We would have 5 patients (6 at most) daily…with hopefully two nurses aides. In a regular day, if I am lucky, I might have one walkie talkie patient (someone who is able to get around and do things independently), a frequent flyer or two, and either 2 or 3 more patient’s who had undergone some sort of surgery. Now that might not phase those who don’t work in the field. “Oh, it doesn’t sound so bad! Why would anyone complain?” Well, let’s see…I’ll outline some of my most memorable patients as best I can…these are people I had frequently. Then I might outline an entire day from memory, if I have time. If not, I’ll follow up this post with another.

Let’s get on with it, shall we?

Patient A: mid-50’s, overweight male. This patient had had several flap surgeries on his buttocks due to pressure ulcers. Simple, right? No way. Not only was this patient paraplegic, he also had a right above the knee amputation due to his uncontrolled diabetes. He had a Hoyer lift in his room, which he never wanted to use. He was on chronic pain medications and would demand that they be given in the exact way and time that he wanted. If it wasn’t given at the EXACT time, there would be hell to pay. His glucose constantly ran in the high 300s and would refuse his insulin each time he was scheduled for them. Not only that, but he decided that he would be completely non-compliant with his diet. Every day, he would ask for two hamburgers, 2 puddings, and 2 whole milks. And the hospital kitchen staff would comply with his request or else he wouldn’t eat… or worse, throw a tantrum. Yes, that’s right, throw a tantrum. A 50-something year old man. A tantrum. He would yell, scream, grab his call bell and try to hit the nurses, grab milk cartons, spoons, plates and hurl them at anyone who upset him. On some strange occasions, he would acquire a “baby” voice and start calling several nurses “mommy” and revert to a child-like state. On top of all this, he was MRSA positive, which meant every time we would be called into his room, we had to gown and glove.

Patient B: 50-ish woman who was really a man. This was an interesting one due to the patient being very adamant that only certain nurses see her. I understand that, don’t get me wrong. She was a female with male parts – a penis and scrotum to be precise. She would tell people that she didn’t need to get out of bed to urinate because she could “position” herself over a urinal and urinate that way. Well, anyway, she would come in every month or so and we would all dread being chosen. I was chosen more often than not by her…but she had the worst attitude with everyone. I hadn’t had this patient for a while when I heard that she accused a nurse (one of my co-workers and friends) of not giving her pain medication when it was clearly documented in our electronic medical record. Well, much to my surprise – although I probably shouldn’t have been too surprised – she accused me of the same thing. I still don’t know what her angle was to say these things, but it didn’t get any of us nurses in trouble because everyone was aware of her.

Patient C: A patient who was paraplegic, in his 30s. “Fired” me as his nurse because I misunderstood what he wanted – instead of placing a bottle of lemonade in the water pitcher full of ice, I poured his lemonade into the water pitcher full of ice! How dare I? His exact request was, “Take this pitcher, fill it with ice, and then put this lemonade in the ice.” Apparently to him, this was a clear request. I don’t know, you guys tell me, was I deserving of being called an “ignorant nurse” for doing as he asked?

Patient D: This one is more about the patient by the door instead of the window, however you must understand what was going on with the patient at the window to see why I was so annoyed with the patient near the door. Patient at the window was mentally handicapped, unable to even transfer himself from bed to wheelchair. Because of this, we had to use a Hoyer lift any time he would need to be transferred. Well, this patient was finally being discharged. Unfortunately, he had just soiled himself and had to be cleaned and dressed prior to being transferred to his wheelchair. So, even though his group home caregiver was with him, she did absolutely nothing. Well, my aide and I clean him up and get him dressed. Put him on the Hoyer and transfer him to his chair. What happens? He soils himself again. Back into the bed he goes with the help of the Hoyer lift. The process starts all over. Now remember, please, that this space can’t be more than 10 feet, if that. We have 3 people in the room, not including the patient. It is hot, it is small, it is claustrophobic. With the machine in the room, it’s nearly impossible to maneuver. Well, finally, an hour later, we are all done and the patient is being wheeled out of the room. As I walk past the door side patient, he says very arrogantly, “I asked for my pain medication an hour ago.” Now, don’t get me wrong, I don’t play with anyone’s pain medications – I am very aware that people need their drugs for comfort. HOWEVER, you just heard my aide and I struggle for an hour with this other patient; I’ve had not one minute to recuperate, and you are going to be arrogant about it? Please, tell me I’m wrong.

These are just a TINY TINY portion of the patient’s I’ve encountered. I have dozens, if not hundreds, more. Add to it minimal breaks (30 minute lunch for a 12-hour shift with two 15-minute breaks), nurse managers who do nothing to help but constantly criticize and assistant nurse managers who couldn’t bear to stand up to help for a second and you have only a small idea of what hospital nursing is about. The beauty of hospital nursing is usually your co-workers, who understand you, cheer you on, and hopefully help you if they aren’t swamped – which is a rarity.

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Be Thankful. 


Earlier today I was thinking about the people I work with. I don’t mean my coworkers. I mean my patients. I have a good amount of younger patients whose situations are more than upsetting. I have a 30-year-old patient who is blind, cannot move on her own, is non-verbal, has to have tube feedings for nutrition, a Foley catheter to urinate, a tracheostomy to breathe, and is completely incontinent. I have a 31-year-old patient who has gastroparesis and has lost over 200 pounds in the last 6 years because of it. She now has a feeding tube and an emptying tube in her stomach so that she can receive the nutrients she needs and then empty the leftover contents of her stomach into a drainage bag. I have several patients with cancer. Several have been in terrible car accidents. I look at all these people and give thanks that I am able to do what I do everyday. Some days I feel worst than others; more pain, more fatigued, more unhappy. None of those days have been as bad as the ones people I’ve helped and am helping have been going through and have yet to face. I pray daily that I’ll never end up the way my patients have, but that’s never a certainty. Some days it’s harder than others, my moods fluctuate, my body decides not to cooperate, I hate myself one day and love myself the next. I try to be grateful for everything I have because I’m aware that in a moment it could all disappear. Too many of us believe that we can wait to say sorry, to talk to that person you’ve had a fight with later, to see that family member at the next event. Unfortunately, it’s not necessarily plausible to think that way. What if you wake up one day and find that the person you’ve been having a petty fight with is gone and you never got to spend a last happy moment with them? What if that person is fighting a physical or mental illness that nobody knows about? How would you feel? What would you do? Regret is one of the worst feelings in the world. Is a ridiculous fight worth it? Worth the pain, the rage, the time and effort? I don’t believe so. Say I love you. Say thank you. Say I forgive you. Say I’m sorry. Love each other. Be thankful. Be grateful. Be humble. 

Home Care

I don’t think I’ve ever felt as useful as a registered nurse as I have lately. I finally feel like I have the time to give to each of my patients because I am not bombarded by tons of visits a day. My preceptor is amazing, she is really an inspiration. She cares so much about her patients and their families. In the past couple of weeks I’ve been able to perform things they don’t have us do in the hospital and things that I didn’t have to do at my last agency. Highlights have been: changing out a suprapubic catheter, changing a Foley catheter, setting up tube feedings, working on tracheotomy patient’s, etc. True, some things I listed are done in the hospital by nurses, but I haven’t had the opportunity to do them in the home and it is exciting! I am going to be taking blood in the home for lab tests, putting in IVs, giving IV medications, taking down chemotherapy, performing all types of wound care, taking PT/INR with the CoAguChek machine, etc. I don’t think I’ve ever been so excited or happy. Most of my co-workers are fantastic and my preceptor is becoming a friend to me and that makes me relieved and happy because in NYC you don’t get a lot of friendship – especially in the home care field. The orientation period is long but it is extremely worthwhile. I absolutely love that we shadow and work with a seasoned nurse for 3 months. It helps immensely. You can only learn so much in a classroom. The best part is that my preceptor told me today that I am her favorite orientee because we are so similar and I learn so quickly (although that might be because I’ve done home care before). Either way, I feel enthusiastic with this new job. I feel like I can flourish. I feel like they actually care – especially about family matters and work-life balance. In my previous job, I would work at home until 10, 11, 12 o’clock at night and no one cared – it was expected. Here, they want you to be finished with everything by 5PM. If you work after 5PM you have to give a good reason and you’ll get a talking to from your supervisor, because it is not supposed to happen! They want you to be able to have a family and social life. That is such a far cry from most places! Needless to say, I am happy I chose this company to work for…and the funniest part is, I didn’t want to be in home care again! Interesting.

Go Speak to Someone Today…

I started my new job yesterday. I’ll be doing Home Care Nursing in Pennsylvania – a far cry from New York City. These first two days were orientation days; lots of general information about the organization, policies, corporate compliance, blah blah blah. Typical orientation things. We got to sit in groups at circular tables. The people I sat with were amusing, personable, and intelligent. Three very nice people. One will be a Patient Care Assistant, another a Customer Service Representative, and the last will be doing what I will be, but in a different area of Pennsylvania. The other RN is a male nurse, adorable, big blue eyes, nice smile, the whole bit. Out of all of the others, I had some great conversations with him. I am so awkward around men usually, but the conversations were intelligent and fun. It was much needed. Now, reader, don’t get me wrong – there definitely is no love connection or whatever you might be thinking. My real point in singling him out is that we were able to talk. To communicate. It is so difficult at times to speak with others, to find a topic and to roll with it – at least for me. A lot of times that happens with my own husband.

I remember when we first started dating…we would have conversations about anything and everything. We would laugh, cry, enjoy our time together. We would stay on the phone until 3 A.M. and then play the “you hang up first” game. Now, I rarely have a topic to speak about and so does he. Don’t get me wrong, we do speak, but I feel like it has most definitely dwindled. I’ll ask him to start a conversation and he will tell me that I should…because I never do. Really? In general, I am not a big talker. I’d rather listen most of the time and hear what is going on with others rather than speak and possibly make a fool of myself. This should come as no surprise to my husband, as we’ve been together for 7 years. I miss the way it was. It was carefree and lighthearted and fun. Everything seems to have been dragged down by ill will, bad feelings, stress, work, etc. It upsets me to no end. I wish I could get the spark back. Sometimes I wonder what happened – like I don’t already know.

Communication is so important. In relationships, at work, with friends, family, and literally every aspect of everyone’s life. Either physical or verbal. It is IMPORTANT. The problem with most relationships is that communication is lacking. Without it, how would anyone know your emotions? Your likes? Dislikes? Loves? History? Present? Future plans? Goals? Anything? They wouldn’t. Without communication, life would be extremely boring. I wish more people would understand that. By “talking it out” so many problems could be resolved or avoided, so much understanding could be wrought, so much hate could be diminished.

 

Go speak to someone today.
And really listen.
They might need it.