nursing

child handling for the childless nurse

My current job has me working with children, which is kind of a weird shock after years in environments where a “young” patient is 40 years old.  Here’s my impressions so far:

Birth - 1 year: Essentially a small cute animal.  Handle accordingly; gently and affectionately, but relying heavily on the caregivers and with no real expectation of cooperation.

Age 1 - 2: Hates you.  Hates you so much.  You can smile, you can coo, you can attempt to soothe; they hate you anyway, because you’re a stranger and you’re scary and you’re touching them.  There’s no winning this so just get it over with as quickly and non-traumatically as possible.

Age 3 - 5: Nervous around medical things, but possible to soothe.  Easily upset, but also easily distracted from the thing that upset them.  Smartphone cartoons and “who wants a sticker?!!?!?” are key management techniques.

Age 6 - 10: Really cool, actually.  I did not realize kids were this cool.  Around this age they tend to be fairly outgoing, and super curious and eager to learn.  Absolutely do not babytalk; instead, flatter them with how grown-up they are, teach them some Fun Gross Medical Facts, and introduce potentially frightening experiences with “hey, you want to see something really cool?”

Age 11 - 14: Extremely variable.  Can be very childish or very mature, or rapidly switch from one mode to the other.  At this point you can almost treat them as an adult, just… a really sensitive and unpredictable adult.  Do not, under any circumstances, offer stickers.  (But they might grab one out of the bin anyway.)

Age 15 - 18: Basically an adult with severely limited life experience.  Treat as an adult who needs a little extra education with their care.  Keep parents out of the room as much as possible, unless the kid wants them there.  At this point you can go ahead and offer stickers again, because they’ll probably think it’s funny.  And they’ll want one.  Deep down, everyone wants a sticker.

Just the Nurse

“It’s just the nurse”
A statement I’ve heard more times than I can recall.
A statement I vacillate between being utterly pissed off at; given some people take for granted what we do, take for granted how consistently we are the ones by their side and not seen - and a statement I’m also sometimes not offended at, pausing as I consider how perhaps we’re simply seen as a circle of trust.

Just the nurse who caught the baby’s heart murmur

Just the nurse who listened when everyone else walked out the door

Just the nurse who carefully cleaned parts of you when others shouted what’s that horrible smell in that room.

Just the nurse who had to call your annoyed provider 5 times just for them to come talk to you and answer your questions

Just the nurse who threw their back out from years and years of physical exertion with turning and positioning.

Just the nurse who contributes daily to interdisciplinary rounds, to discussions surrounding your care for the day

Just the nurse who advocates for quality of life discussions

Just the nurse who helped the baby docs when they were med students, when they were residents, when they were scared.

Just the nurse who continues to advocate and work collaboratively with your doctor so you get the kind of care our system so ardently resists.

Just the nurse who teaches the new mama how to hold, nurse and bathe their baby

Just the nurse who cared for you over and over, day after day, admission after admission for 12 hour shifts and made you their world

Just the nurse who fights hard for safe staffing ratios so you get the quality of care you deserve.

Just the nurse who stands their ground and tosses out anyone who interferes with your healing or recovery time.

Just the nurse who prayed for you when science no longer had any answers

Just the nurse who cares for you as you take your last breath

Just the nurse who comforts your family when they have nowhere to go with their grief.

Just the nurse who gently wraps you in a shroud and pauses quietly to keep you in their own memory and heart

Just the nurse who doesn’t demand you respect us, rather quietly asks that you don’t insult our presence.

Just the nurse, the highly educated bachelors, masters, and doctorate level prepared, certified nurses who worked hard to attain the scientific and evidence practice based knowledge that will help save your life.

Just the nurse who isn’t perfect, but works every day to learn more and perfect their care.

Just the nurse who goes home and cries for you.

Every other day, Every other week may in everyone’s eyes be about every other provider, but let today, let this week not be an insult; let it just simply be about the nurse.

Happy National Nurses Day,
Happy National Nurses week -
To “just” the nurses.

I think, instead of telling kids ‘don’t do drugs, they’re bad’ we should show them the opiate withdrawal patient I had the other day

25 years old, in jail for god knows what, cops bring him in with a lac to his forehead from banging it on the wall repeatedly. He is already handcuffed so we put him in an isolation room, with sliding glass doors. Because he is in custody we take everything but the bed out of the room. 

Patient is screaming the whole time he doesn’t want to be there (same bro) with blood everywhere from the head lac. 

5min later, I hear this sickening crash, I’m pretty sure someone has just run head first into the glass doors, because mate I’ve done that before those curtains are assholes, so rounding the corner I see blood all over the glass door, patient still screaming he wants out but is now banging his head on the glass. 

It takes 4 security guards to hold this guy down, he is absolutely losing his shit, screaming and flailing and has no idea whats going on. Calling out for his mom, for Neil (???), for a sandwich, doesn’t know what day it is or just refuses to answer we can’t tell, pupils 4mm and sluggish but thats how it was when they brought him in, so security cuffs him to the bed so he can’t hit the wall. 

Fastforward 10 minutes and he has dislocated/broken his wrist trying to get out of the bed and to the door, he has puke and stool everywhere, refused to take the ativan so we gave midaz, but that didn’t touch him. 

This guy screamed from 2-7, we maxed out what we could give him for benzos and he was extraordinarily agitated and wouldn’t settle and was only in the beginning stages of withdrawals. It was terrifying, but the thing that got me was after screaming about how we took the 20′s (from his underwear??) he was quiet for a minute, I thought ‘shit the midaz finally caught up with him and now were gonna need to intubate’ but he then screams

“I don’t want to do this anymore, I don’t want to be on drugs anymore, I want this to stop, I want to be clean, please someone help me”

And thats what got me. This guy was 25, had his whole life ahead of him, but got caught up in drugs and it was going to kill him, and he wanted out, but withdrawals were so bad that it was easier to keep using. 

Fuck telling kids don’t do drugs. Show them what its like to try to stop, how all your friends die from OD, how you are one phonecall-not-made away from death yourself, how you get to be tied to a bed in the ER and your nurses need to apologize to other patients because you can’t stop screaming and just shit yourself and puked the cookie I gave you and your body is on fire. 

Don’t just tell them not to do it, because that doesn’t work, show them what its like to try to stop, because sometimes fear works better than facts. 

Note: Throughout the day we gave him 4 of ativan, 27.5 of Midazlolam and 12 of haldol, and this guy still was still agitated and screaming and 100% inconsolable, and by that time the doc was like ‘we can’t give him anymore, but lets transfer him out before he crashes’. It was a fucking time

Hospital Jargon (as explained by an American floor nurse)

Writing something that takes place in a hosptial? Consider this list of phrases to add a sense of realism:

HOSPITAL LIFE:

Report/ in report: When one nurse hands their patients off to another

PACU can f*ck right off until 1930, we’re in report.

Sign-Out: When one doctor/resident hands their patients off to another

*returning page* “Are they dying? I’ve barely gotten sign-out here

EPIC- Electronic charting system. Literally any electronic charting system. Does not have to be Hyperspace/supplied by the EPIC corporation to be called this.

Hey, could you put those vitals in EPIC for me since you’re already logged in?

Bed 45/46-2/47-1/48/etc…: how we refer to patients, by their bedspace number, denoted “room-bed”.

Hey Nikki, do you remember what 45-2′s blood sugar was?

Assignment: The patients any one particular medical professional has responsibility for- be they a nurse, doctor, aide, respiratory therapist, physical therapist, etc…

My assignment is rooms 43-45, how about you?

The Board: Where the status of the patients on your floor get listed, including who is to be discharged, who has certain needs, and the day’s expected admissions. Used to be a physical white board, but now is electronic. Usually used to talk about how many patients a floor is about to admit.

“Jeeze, did you see they just put four new patients on our board? We’ve already got 16- call the nursing supervisor.”

Flexed up: Taking more patients than you’re staffed for on a floor

Well, we’re staffed for 15, but they ‘found’ three more bedspaces so they’re flexing us up tonight.

Code/Call a code/They’re coding: A Code Blue. When a patient’s heart stops on The Floor and everyone shows up to practice CPR and transfer them to The Unit.

They’re coding, get a crash cart to 75-2 and call a code blue

Rapid/Call a rapid/Rapid response team: Almost a code, but their heart is still beating. For hospitals who have a separate “Rapid Response” nursing team. Two Crit Care nurses show up and handle things. Also who you call if you and everyone else on your floor can’t get an IV.

They have an INR of 9.5 and the doc doesn’t want to do anything- I’m gonna call a rapid.

Float/they’re floating you: When you don’t have enough patients on your floor so the nursing supervisor sends you to a different, unfamiliar one.

They’re making me float to 9C. Again. Can you believe that??

Full: Can’t take any more patients, either due to physical space or nursing staff.

Tell the nursing supervisor to stop putting patients on our board- we’re full

Clinic: Outpatient. Where you want your patients to be.

Tell them we’ll see them in Clinic in three days. They have no medical need to be here anymore and they know it.

KINDS OF PATIENTS:

Contacts/isolations: Any patients who’s rooms you have to don a gown, gloves, mask, and/or respirator to enter.

Are you sh*tting me? I have five patients today and four of them are isolations.

Frequent flyer- Someone who, for medical or social reasons, just can’t seem to stay out of the hospital

Did you hear Darlene is back?” “Yeah, we’re officially engraving her name on the Frequent Flyer wall of fame

Crump/Crumpy/Crumper: Colloquial term for patients who are medically unstable/at a lower level of care than they need/will be transferred to The Unit when a bed becomes available or when the inevitably code, whichever comes first.

73′s a crumper if I’ve ever seen one. Rapid’s in there working her now.

‘Seeker: Someone in the hospital with their own agenda, but who largely has no medical need to be there and will threaten to sign out AMA (even though they’ve been discharged four times and keep refusing to go) if they don’t get what they want- be it drugs, social interaction, or over-the-top waitressing. Will probably threaten to give a horrible review of the hospital on their social media platform of choice and mention you by name if they don’t get what they want.

49′s a total seeker. When she’s not begging for pain meds, you’re getting her crackers, juice, tea, hot packs, cold packs, everything you could think of. I didn’t sit down all night and my other patients slept pretty much the whole night. Give her some percocet and get her the hell out of here before I have to deal with her again tonight.

Heavy: A patient that takes up a disproportionate amount of your time, but usually for a legitimate reason.

Dr. P’s patients are really heavy. Something’s always going on with them and they have tubes coming out of everywhere that need care of some kind every hour… I had two of his patients today and I’m so tired… could we break up the assignment for the next shift please?

HOSPITAL PLACES:

The Floor: Medical and Surgical floors, sometimes specialty floors- basically anywhere that’s not the ED, Psych, or The Unit. These have higher staffing ratios (more patients per nurse) and lower patient acuity than The Unit

They didn’t really need a bed on the Unit so they were transferred to the Floor

The Unit: The Intensive Care Unit. Where crumpy patients go, comes in the following flavors (though smaller hospitals may have just one): MICU (medical), SICU (surgical), PICU (pediatric), TICU (trauma), NICU (neonatal), NICU (neurological), BICU (burn), and Stepdown (in the days after an ICU discharge).

They weren’t doing so hot, so we called a rapid and had them sent to The Unit.

The ED: The Emergency Department. Oh dear lord it is not called the ER.

They’re sending up that new admit from the ED in like 5 mins, do you have the room ready?

PACU: Post Anesthesia Care Unit, where people are stabilized after surgery.

PACU’s calling again, they’re backing up and need to give report.” 

THE NURSING HIERARCHY:

Director of Nursing: One Nurse to rule them all. Directs all facets of nursing, from training to hiring to staffing to quality improvement.

Nursing Supervisor: One nurse to rule them all… on a given shift. The nursing supervisor assigns patients to nursing units and makes sure everywhere is staffed accordingly.

Nurse Manager: In charge of the general staffing and personnel management of a particular floor, including scheduling, patient satisfaction, staff development, and service recovery.

Charge Nurse/Charge: The “shift manager” of nursing. Has final say on a lot of things you don’t want to be the bad guy on, as well as creating assignments/checking the crash cart, and submitting service requests when the nurse manager isn’t there. Also has a patient assignment.

Staff nurse: The nurses who do assessments, pass meds, start IVs, carry out orders, give updates to doc’s, chart, manage a patient’s day, make sure they get to tests/procedures on time with the right paperwork, and are overall responsible for managing patient care and providing first-line response to issues that arise throughout the shift.

Nurse Aide/Nurse Tech: Provides the majority of basic patient care. Counts intake and output, gets blood sugars and vital signs, sets up rooms for new admits, cleans and clothes patients, gets blood and urine samples, transports patients if necessary. Staff nurses are responsible for this when aides/techs are not available.

Would someone please add the Medical Hierarchy if you know it? I don’t feel I know it well enough to do it justice. Thanks!

What I wish I could tell other people about nursing

Nursing is messy.
Nursing is chaotic.
Nursing is twelve and half hours in a shift.
Nursing is never enough time to get everything accomplished.
Nursing is charting. Endless charting.
Nursing is waking up in a panic about something you did/said/didn’t chart.
Nursing is hard.
Nursing is breaking my body.
Nursing is glorious.
Nursing is beautiful.
Nursing is the awe-inspiring moments you get to witness.
Nursing is being present for the gut-wrenching moments you wish you could walk away from.
Nursing is fighting for your patient.
Nursing is a good bit of skill and a lot of luck.
Nursing is listening.
Nursing is educating.
Nursing is a profession.
Nursing is a gift.
Nursing is a curse.
Nursing is being afraid I’m going to get sued no matter what I do.
Nursing is lying awake at night wondering about patients you took care of and where they are.

Nursing is all of these things and more. Sometimes nursing is all of these things in the course of one day.

Shoutout to the girls doing ‘dirty jobs.’ The women who can’t wear makeup, nail polish, flattering clothes or have piercings and tattoos when at work. Props to the ladies who come home with dirt under their nails, stains on their uniforms and smells stuck to them that cannot be washed away with a single shower. To the girls who don’t feel pretty in their workplace. To the trans girls who cannot yet pass in the workplace. I see your dirt, smears, scars and dry skin. I see your scrubs, coveralls, aprons and smocks. I see your messy buns and steel-toed boots.

Your hard work is beautiful. Your blood, sweat and tears are worthy of respect. I am so proud of you and all you do. You are just as stunning in your work clothes as you are on a night out.