Saturday, September 19, 2009

Visitors and Patients: Before Entering the Unit, Please Watch This 300 Minute Video on What To Expect In The Hospital




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In my last poll, one person voted for the comment, "I don't know what they do all day long!" Sadly, I hear this kind of comment a lot from the general public. People have no idea what nurses really do. When I graduated from nursing school, after one month I realized that nursing school nursing is far different than reality nursing is. Most people don't ask specifically how I spend my time but I know that in Canada, there are many people who wonder what all the fuss is about nurses.


I've compiled a list of jobs that we do. There are two sections. The first section talks about what nurses have been trained to do. This list is just an example of what we do. It is not conclusive. I'm sure I have missed many areas of nursing. The point of this list is to show you what areas we specialize in. The second list is a list of roles that we play as nurses. This list is composed of everything that we do and oftentimes it is this list that takes up most of our time. Instead of focusing on patient health and the well being of patients by helping them to return to their baseline (how their health was before they entered the hospital), we are busy catering to the "expected" needs of the patients.

Our Expertise:
*conduct assessments
*document
*start IVs, PICC lines, CVC lines
*change dressings
*filling orders
*giving medications-scheduled and as needed
*reporting to other nurses, charge nurses and to physicians
*consulting with various members of health care professionals: physio therapists, occupation therapists, social workers, spiritual care workers, physicians, lab technicians, etc.
*conferencing with physicians
*analyzing blood work, various diagnostic tests,
*drawing lab samples
*observing patients/continuing to assess them throughout our shift
*critically thinking about changed patients' health-during critical incidents as well as during patient progress

I'm sure there are many more things that we do in the day but this is a quick list of nursing skills.

Nurses also are:
*secretaries
*housekeepers
*security guards
*social workers
*porters
*physio therapists
*occupation therapists
*behavioural therapists
*politicians
*ministers
*bouncers
*grief counsellor
*pain manager
*financier
*waitress (without the bonus of getting tips)
*counsellors
*language translator
*sign language user
*babysitter
*activity coordinator
*transition worker
*psychiatrist

Of course this list does not include everything that we do.

Now that you know what we are meant to do and what we do do, do you realize how much time is spent on fluffing pillows, answering call bells (oftentimes when patients press their call bell, they do not want more medication and they certainly do not want to know what more they can do to get out of the hospital). Sometimes I spend more time filling water jugs, emptying urinals, and trying to convince patients to get out of bed than I do taking care of the physical needs of patients! At the end of the day, I usually try to look back at all that I have accomplished. Sometimes it is a lot! Sometimes I feel like all I've done is babysit those people who really should be out in the world enjoying the fresh air, reading a good book. instead of focusing on those things, they focus on verbally abusing me, criticizing my nursing skills, gossiping about me with their roommate and demanding to know why they have to share a room! It is these little irritating complications in the day that make me wonder why I became a nurse in the first place.

I would love to see an orientation class be organized for every patient, every family member and every visitor that enters into the hospital. The class would let them know what they can expect from the medical team and what they are not to expect from the medical team. If I were teaching the class, this is what I would tell the people.

1. Just because you want to talk to the doctor, does not mean that the doctor can talk to you at that very moment.
2. You WILL be sharing a room. Only the sickest of the sick get private rooms. Only those who need to be in an isolation room will get private rooms.
3. As visitors, you cannot stay until all hours of the night. If you come to the hospital, you have to help! You cannot sit in your comfortable chair while the nurse is struggling to help your obese loved one from her bed into a wheelchair. You must get out of the chair and help!
4. You must stay all day if your loved one does not know a word of English! You must be readily available to translate for us.
5. You cannot sneak your loved one food when they are supposed to be "NPO" (nothing by mouth) before surgery or a diagnostic test.
6. You need to be aware that hospitalists make rounds when they make rounds. We do not have a schedule written out for your convenience as to when you will see him. We cannot determine that Dr. S will be at your room by 11:30 a.m. every day. If you want to discuss an issue with your doctor, you need to bring it up WHEN you see him! If your family wants to discuss your health, they will need to come early in the morning and wait until the doctor has come.
7. We will NOT page the doctor just because you want to talk to him. If it is an emergency, we will page him. We will NOT page the doctor if you are having a hard time changing the channel on your TV!
8. Even though you fill out a menu daily, this does not meant that you will get exactly what you requested! We will NOT call the kitchen, or go to the kitchen to get the salt/pepper that you forgot to order.

The list could go on and on.

I know it seems like I'm not caring. I know it seems like I'm being rude.
If I were not a nurse, then I would think that "Wow! This person is rude and isn't caring!"
Only nurses know how demanding patients can be. Only nurses know how inconsiderate and selfish patients and their families can be. Yes, I know that your loved one is really important to you, but what you must understand is there are many people in the unit. You must realize that we are pressed for time, resources and for nurses.

What saddens me the most is the fact that I cannot sit down with a patient for more than 2 seconds without having to rush off to bring someone a cup of ice water. I cannot talk with patients about their feelings, their desires, or their sorrows because of my beeper constantly ringing.

I was recently at a training day and the instructor was teaching the class how to effectively listen and communicate with patients. I kept on thinking, I would love to spend the time to really get to the bottom of why my patient is crying, but instead, I have to empty the garbage, restart an IV on someone who keeps on pulling out his IV, and call the doctor because a family member is throwing a temper tantrum at the desk. I would love to be the kind of nurse that I was told I could be in nursing school. I would love to really HELP a patient instead of catering to their roommate who refuses to brush their own teeth, eventhough they can brush their own teeth and they were brushing their own teeth before they were a patient.

I try my best. I am caring. I am sensitive. I am empathetic. I am also tired of hearing only negative things about nurses. I am tired of being verbally abused. I am tired of having to spend more time being a housekeeper and a waitress than I have the time to counsel a patient on whether they should have the surgery, or provide education to the patients about their medications and the need for these medications.

The next time you wonder how a nurse spends her/his day, please refer back to the lists I have made above. Please do not criticize us until you have walked in our shoes. In return, I will try to treat your loved one as though they were my loved one. I will also try to spend a few more minutes with that patient who keeps on crying, or the patient who has no visitors.

Wednesday, September 9, 2009

Reality

This is my first time blogging. I have no idea if anyone will read this, but I thought I would give it a try. I got inspired to write this blog after seeing the movie, "Julia & Julie". This movie is starring Meryl Streep and Amy Adams. Julie works for a dead end job and starts a blog to find challenge and fulfillment in her life. She is inspired and in awe of Julia Child (played by Meryl Streep). Julie decides to write a blog about her experiences of making 524 recipes from Julia Child's cookbook, within 365 days! The movie is a feel good movie and it is mostly about (and more interestingly about) Julia Child. What an awesome woman!
I decided today that I don't necessarily need a challenge of making all of Julia Child's recipes in a year, but I do need something that will help me get through another challenging day of being a nurse.

The Realities of Nursing
I learned that being a nurse in the real world of nursing is quite different compared to being a nurse in the make believe world of nursing.
In the make believe world of nursing, the following things happen:
1. All patients are nice and thankful for your care.
2. You can approach any and all doctors with questions and suggestions for patient care.
3. All patients will learn from the education you provide them and they will change their ways.
4. All nurses are helpful, enjoyable to be with and will teach you the ways of the nursing world.
5. It is easy to transfer to other units, to find challenging experiences and to build your resume.

The reality is:
1. There are many patients who are nice and appreciative but so many who are not. I have been been verbally abused by many patients. I have been spat upon, kicked, pinched, hit, sworn at and ridiculed.
2. I have learned that it takes time to get to know each doctor. There are some that will always have time to answer my questions or will try my suggestions. There are others who don't give you the time of the day or even try to learn your name. To them, you are a nuisance, an interruption in their already very busy day. To some, you are "just" a nurse.
3. Many patients do not want to return to the hospital, but I think deep down, a lot would love to stay in the hospital. They get three meals a day plus snacks. They do not have to clean up anything. Many nurses will cater to the patients' every whim and they like it. Many patients do not want to change their lifestyle. This is what we call "having poor insight into their condition and health". Most do not think that smoking is detrimental to their health. They enjoy drinking alcohol and do not plan on stopping. They like living on the streets because "There are nice people on the streets!" They do not understand that they are taxing to the health care system. They do not realize or care to realize that they are using up a hospital bed. They have not thought about the critically ill patient in the emergency who desperately needs a hospital bed.
4. There are many, many nurses that are willing to help others. The sad part of nursing is that oftentimes we would like to help each other out more but we have time restraints to deal with often. The other sad part is that most nurses are women and women tend to be catty. We gossip, we talk about each other, we get frustrated easily and sadly there are many cliques.
5. I have found that it was quite easy to get a job as an RN, but it is difficult to transfer to another unit. There are many roadblocks. Many of the jobs usually go to someone on the unit already. They need nurses but there are many rules and red tape to get through first.

It was hard to learn these realities, but I realized these lessons and others within the first year of nursing. To be honest, my hopes and dreams of the human race were somewhat dashed. I imagined that I would make an impact on my patients' lives. I would help them to renew their strength and return to their lives healthy. I had originally thought that everyone would want help but that is not the case at all. Do not get me wrong, there are many patients who do want to get well and get back to their life, but there are some days when I think that those patients no longer exist.