registered nurse

The patient satisfaction movement will be the end of nurses

((Beware, this one might not be a popular opinion but I don’t care anymore))

I’m sorry that I’m not focusing enough on how “pristine” your room is while I’m trying to keep you and your baby safe. That I’m not catering to your every whim and bringing rounds of ginger ales for you and your eight family members every 30 minutes. I am not a waiter. Will I bring you ice and ice water and popsicles and jello? Absolutely. You are the patient and in labor. I am here to help you. I will not be an on call butler for your entire family.

I’m sorry that I don’t treat you like you are at a five star resort and spa. That I don’t provide foot rubs, pedicures, back rubs, cucumber water and hot towels for your hands. 

Here’s an idea, if you want to be treated like you are at a five star spa, GO TO A FIVE STAR SPA. Don’t show up at your local hospital. Where I’m overworked, stressed out, haven’t peed in six hours, and haven’t consumed a meal outside of the nurses station in two years. OH, and where I hear constantly about how I’m not doing enough to make my patient’s stay satisfactory, pleasurable, or perfect. 

I’m sorry that I cannot make your pain your desired pain goal of zero. That is not a reasonable pain goal. You are here to have a child. Either out your vagina or through a large abdominal incision. ZERO IS NOT AN ACCEPTABLE PAIN GOAL. You will never have ZERO pain if you are experiencing childbirth (or in a hospital period). Hospitals are not spas or hotels or resorts, in spite of the daily housekeeping and room service. Hospitals are not a pain free experience, no matter how you look at it. 

When EVERYTHING in the hospital is about how wonderful the patient’s “experience” was, you (MANAGEMENT) are focusing excessively on the wrong things.

I am your labor nurse. I am here to keep you and your baby safe. I am here to provide the safest, happiest birth experience I can give you. I am here to honor your wishes in every way that I reasonably can. I am here to support you, to educate you, to hold your hair when you puke, and to coo over your beautiful baby when they’re born. I will support you, I will laugh with you and cry with you.  

But most of all I am constantly assessing and evaluating and critically thinking about what is going on with your body, your health, your baby. As I fluff your fifth pillow to give you more cushion in our horribly uncomfortable beds I am also worrying what will happen if your blood pressure drops dangerously low after an epidural, what happens if your baby’s cord prolapses and you need a stat c-section or what happens if God forbid you get an amniotic fluid embolus and you are dead before I can get you out of the room. 

This is what I’m contemplating on a daily basis. I understand this. I understand the responsibility I took on when I became a nurse. 

I’m telling you I cannot continue to be a excellent, safe, careful, competent nurse if I’m worried about getting in trouble with my boss because there was a lunch tray left in my patient’s room mid-afternoon or that housekeeping didn’t come fast enough to mop up a spill or that I didn’t bring my patient enough gatorades. 

I am telling you that focusing ONLY on patient satisfaction scores as a measurement for hospital performance will be the end of bedside nurses. 
All the excellent bedside nurses will be gone. We can’t take this. Day after day, year after year. We will go back to school to become NPs, CNMs, educators, or nursing instructors. We will not stay at the bedside. 

We will not stay in a job where we are told our only worth is how “enjoyable” our patient’s hospital stay is. 

I am a nurse. But I will not fight to stay in a job where I get told that everything I do is not enough. That my best is never enough because the patient didn’t mark “Always” enough times on their HCAPS survey. 

I will never be enough. 

NCLEX Pharmacology Medical Suffixes

  • -amil = calcium channel blockers
  • -caine = local anesthetics
  • -dine = anti-ulcer agents (H2 histamine blockers)
  • -done = opioid analgesics
  • -ide = oral hypoglycemics
  • -lam = anti-anxiety agents
  • -oxacin = broad spectrum antibiotics
  • -micin = antibiotics
  • -mide = diuretics
  • -mycin = antibiotics
  • -nuim = neuromuscular blockers
  • -olol = beta blockers
  • -pam = anti-anxiety agents
  • -pine = calcium channel blockers
  • -pril = ace inhibitors
  • -sone = steroids
  • -statin =antihyperlipidemics
  • -vir = anti-virais
  • -zide = diuretics
On Anger at the Healthcare Machine.

I follow our INR patients on coumadin on a weekly to monthly basis. There was one patient, Randy, who was never quite compliant, but was always cheerful and friendly. 

Randy liked his drinks, and would joke when his INR was too high or too low that it “must be the whiskey”. Randy was on warfarin because of a heart valve replacement about 10 years ago. In the beginning, I always chastised him - nicely - to not drink and to do better to have his INR taken when I told him to take it. But overall, he was not a difficult patient and I always looked forward to getting to talk with him.

On one of our monthly calls, he had a congested cough, and I heard his wife gasp in the background. He was saying, “No, no, don’t tell them.” and his wife took over. 

“Randy is coughing up blood off and on for weeks now! And he won’t tell the doctor because he doesn’t want to have to take time off work.” 

Rightfully concerned, we made an appointment to see him in the office that week. The doctor ordered an urgent CT scan, only to have it denied by Randy’s insurance. 

Really?! You’re going to deny a CT scan of a man with a mechanical heart valve who’s coughing up blood? Insurance drives me mad. 

After two weeks of appeals and peer-to-peer calls, the insurance finally let us move forward, and he got his CT. I came in the next morning to a flurry of messages in my EMR - radiology apparently hadn’t been able to get ahold of the physician, but there was a problem with the valve and the troubling signs of the beginning of an aortic dissection. The back up doctor called the patient at 5am and urged him and his wife into the ER. 

I checked the chart and saw, thankfully, Randy had followed advice and gone to the ED. Reading through the ED notes, it looked like there were no beds available in the hospital, so he was being held in the ED to await workup with the heart team. I felt anxious and checked his chart every couple hours for updates, along with our physician who called the ED docs for report a couple times that day. We both lamented that it was terrible he had to sit in the ED because of a lack of ICU beds - he should be in surgery already! My doc decided to ask them to transfer to another hospital, but got roadblocked at every turn.

And then…at 3pm that day, I went to check his chart again, and received the notification - “You are entering the chart of a deceased patient. Would you like to proceed?”. I instantly clicked “no” - I must have clicked the wrong Randy!

Typing in the info again, I again got the warning, and my heart sank. 

Randy’s pressure had been climbing, and despite repeated administrations of IV beta blockers, they couldn’t get his pressure down. He gasped, screamed, and began to code. The team knew he’d fully dissected. In less than two minutes, he went from v. fib to asystole, and in less than 15 minutes, they called time of death.

I was mad for days. I still am mad, and that’s part of why it took me months to write this. At every turn, if something had gone better, he’d likely still be alive. 

If he’d told us sooner. 

If his insurance hadn’t denied and fought us for the CT. 

If our CT availability hadn’t put him off two more days.

If the physician could’ve been reached immediately. 

If the hospital would’ve had available beds.

If they would’ve transferred him to a hospital that had availability.

If. If. If. 

So many of the ifs caused by a broken healthcare system in which people you’ve never met determine whether you can have the tests ordered by the physician who has known you for 15 years and went through years upon years of schooling. A system in which state hospitals are overrun with people who cannot afford primary care, often blocking access to people who need it most.

A system in which sees dollar signs in open heart surgery instead of a life to save. 

“Science has taught me that everything is more complicated than we first assume, and that being able to derive happiness from discovery is a recipe for a beautiful life.”
Ever since I was a child I have always been fascinated with science, mostly the biological sciences, the living sciences. Animals, plants, infectious diseases, microscopic beings, anatomy, neuroscience, physiology, microbiology and many more have all captured my attention. I feel as though we should empower and urge women to participate in the sciences not only to make discoveries but for equality. Destroying gender biases and making sure to not set gender norms from an early age will help females feel encouraged to go into the sciences, however a lot of work needs to be done. If we don’t see more women in the sciences, there could be dire consequences. I work as a nurse in healthcare, more specifically on a cardiac floor, I know that often times women present with symptoms that are vastly different than how a man presents with a heart attack. However, in EDs all over the country women are being misdiagnosed and are often sent home where they later have a heart attack. Let’s encourage our daughters, sisters, nieces etc., to follow their passion and encourage them to pursue their interests

I am tired of seeing medical professionals, predominantly nurses, vilified for proper prioritization/time management.
(I also see you, doctor friends of mine! But I am not one so I cannot make a lengthy post about it)

In a shift at the hospital, and in the mind of a nurse, tasks are separated into categories:

Emergent- codes, rapid responses, critical lab values/vitals, change in patient condition that requires immediate intervention, falls, chest pain, shortness of air

Urgent- time sensitive medication (lots fall into this category,) acute wound care, abnormal labs that require time-sensitive intervention, abnormal vitals, suction/chest tube/trach care, pain management

Important- general patient care like bathing, changing, other hygiene, ambulation, phone calls, routine consults, routine labs

These are by no means exhaustive lists, but it gives you an idea of what the nurses/medical team are having to sift through with every single patient of theirs.

Believe me, almost EVERY nurse I know (and I know a lot of us) would get every last thing on these lists done with complete proficiency at exactly the right time every shift…if we could.

But we can’t.

And I get it…I am a BIG proponent of recognizing that hospitalized individuals have heightened emotions secondary to the uncertainty and vulnerability that comes with a hospitalization. This is why I do my absolute best to treat with tenderness as I interact with every patient and cater my care to their needs. And I won’t disclose to my patient WHY I arrive to bathe them an hour and a half later than I had originally said…it is not their fault, or their problem, nor is disclosure appropriate.
But unless they hear “Code Blue” announced overhead, I often get met with anger. They assume I could not have been doing anything emergent, though many emergent things that we do are not announced on the intercom.

And, sorry to be harsh, but your bath fell to the bottom of my list when another nurse called out for help as her patient began to decline, or fell out of bed, or lost their IV access…

(Please, spare me your stories as you try to tell me not every nurse is well-intentioned…“but but but I had an ACTUALLY bad nurse that…”
Sure. Sure you did. And if he or she were actually “bad,” then they ARE NOT the subject of this post. And if they are genuinely neglectful/abusive, they will hopefully/likely lose licensure.)

I am talking about the honest, diligent nurses…
I am talking about the new nurse, who is learning prioritization and time management, but tasks take a little longer…
I am talking about the nurse who would multiply him/herself if they could and be in every room at once…

So, next time you are hospitalized, allow us to be human, and do YOUR best to realize that we are doing OUR best. We know you are sick. We know you are hurting. We want to help; we are doing our best.

(And for the love of all that is holy, don’t get mad if we take a lunch break)

A nurse I work with worked her very last shift tonight after 50 YEARS of emergency nursing. At midnight she emptied her bag, and threw her shoes in the trash, saying “these are done.” I felt like it was such a poignant moment. I know these shoes specifically haven’t seen 50 years of nursing in the ED, but man, think of all those feet have seen.

The little voice.

I get a 54yo male from home c/o severe lower back pain that was sudden onset while watching tv at home. He’s hypertensive on arrival 220/110. I put in my triage, line and lab him. The med student comes in to do her physical assessment and talk with the pt. I see her leave the room with a worried look on her face but she goes back and sits at the doctors desk, the attending is seeing another pt. I asked her what she thought and she very meekly says “I think he may be having a dissection” (he has an extensive cardiac hx) I tell her I agree it’s a possibility and that we need to inform the attending immediately. She looks nervous and she says “but I don’t know, I could be wrong” I said listen you need to trust your gut, if you think this, and this is your assessment, then be confident in it. We inform the doctor who agrees with the med student, I run the pt to CT for a stat CTA, which confirms an aortic dissection. I was so proud of that little med student. And I made sure to tell her that. She saved a mans life and was able to see the full picture and not just the cc of “back pain”. The confidence comes in time but that little voice that tells you something is wrong even if you’re not 100% sure is so important to not ignore. I’m sure she will always remember this, as will I. She’ll make a fine doctor one day. Nursing students, med students, even post school and licensure, we won’t and can’t know everything and will sometimes feel like we know absolutely nothing but we should feel confident in what we do know, strive to learn more each day and always trust your gut. If you at least know normal you’ll know if something is abnormal even if you’re not quite sure exactly what it is.

Originally posted by yourstruly-sassenach

FATRAT - Resp. Distress Acronym

There are a few signs you’ll see when it comes to sever respiratory distress. This is an acronym I use to know what to look for and I will help you by showing what this just might look like to!

F - Flaring (Nasal)

A - Anxiety

T - Tachypnea

R - Retractions

A - Accessory Muscles

T - Tracheal Tugging

These are a few signs of severe respiratory distress. If you have a patient with any of these, you might want to pay attention to them. This means they need help NOW.

One more time the acronym is:

F- flaring nasal

A - anxiety

T - tachypnea

R - retraction

A - accessory muscles

T - tracheal tugging