September, 2005 Archive

September 30, 2005, 8:49 pm

What’s In YOUR Pocket?

Ladies, do you love your undies? Is your bra healthy for your budget?
Are you glad you can stop ironing your unmentionables? I have no doubt that this ad would engender massive amounts of protest if attempted today. Of course, the bra would be an underwire push-up, the bottom would be a thong and the model would be Shakira in a nurse’s cap with a navy blue cape. Of course, they can’t be sexist so there would be a companion ad with Justin Timberlake extolling the virtues of STAT-n’-Strap, the jock strap made for the guy who’s MAN enough to wear the title, NURSE!

Ahem….Aside from underwear, there is more to dressing for work than just putting on the uniform. What about all the adjuncts you need to be at your peak efficiency? The tools of the trade? The building blocks of patient care? Let us discuss these various items.

  • Your ID – you know, the plastic badge with your name on it in big, bold letters. Taping a photo of Catherine Zeta Jones over your photo is not allowed. I tried. It is common knowledge that ID cameras add fifty pounds. They do so!
  • Your stethoscope – You will occasionally be seen to grope at your chest, wondering where it is. You get so used to wearing this that one day you forget to take it off at work and will wear it into the grocery store. You listen to your coughing child’s breath sounds and go to basketball/soccer/volleyball/football practice with it dangling from your neck. You will do this. At least twice.
  • In your right pocket:
    • Scissors. Not those dainty little silver “bandage scissors” that fit so neatly into the little pocket organizer you will never use and couldn’t cut the tip of a Barbie glove. Puh-lease! I’m talkin’ big ol’ trauma shears that will cut through leather. These go in your right pocket with…
    • A tiny calculator. For when the doctor orders 1/748th of the dose you have on hand.
    • Tape. Also in your right pocket. With a tiny fold made on the end so you don’t have to pick at it, especially since they said you can’t wear acrylic nails anymore and you are a chronic nail biter and can’t get the tape to unroll naturally and it’s such a pain and…but I digress.
    • Notepad. Also known as a paper towel, upon which you have written the last set of vitals for the patient in 8A, the results of the urine dip in room 10 and the repeat pain measurement of the patient in 8B who was discharged 30 minutes ago but you haven’t had time to chart it yet.
    • Three quarters, a dime and two pennies that you got as change for your coffee on your way in to work.
    • Two Hershey’s kisses from the candy dish at the nurses’ station, still wrapped but smooshy.
  • In your left pocket:
    • Your precious pens!
      • Your wonderfully smooth writing, gel-based, royal blue Uniball writing utensils, so associated with you that, if found, they are put in your box.
      • A red pen to mark orders you have completed on the doctor’s order sheet.
      • A black Sharpie. Because no nurse should ever be caught without a Sharpie. Their uses are too numerous to list here. Let’s just say that the one time you don’t have it, you will need it.
    • Little plastic thingys that have your hospital’s code system, fire system and Mission Statement written on them for easy reference. They are supposed to be on your nametag but they always fall off.
    • One Hershey’s Kiss. Wrapped and smooshy.
    • Your Palm Pilot. Until it drops out the second time and you go put it back in your purse.
  • On your shoes – shoe covers! Goodness only knows what you’re walking around on in an Emergency department. Blech!

That just about completes the outfitting of the typical ER nurse. I didn’t mention breast pockets because they are useless; bend over and everything falls out. Of the pocket. You could spread out the items by wearing cargo pants but who wants to wear those? Some of us don’t need any additional bulk at the thigh area. Same for those little pouches that you wear around your waist. They’re great!

If you have a body like Shakira…….

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September 29, 2005, 5:15 pm

Incoming!

What a sourpuss! How’d you like your Anacin delivered by this angel of mercy! She looks like she’s ready to administer that entire box per rectum. How DARE you have a headache. How DARE you make her call the doctor
after hours. You. Will. Pay.

Her textbook for Essentials of Nursing 101 must have been “The Patient as Enemy: The Nasty Nurse Model”.

There are times in the Emergency department when even the most dedicated nurse can begin to feel that way. The department is full. You are holding three med/surg and two ICU patients until you can get orders/beds/nurses to move them up. You’re down a nurse because of a sick call and just try to get coverage on a Saturday evening. You have 8 people on the triage list and 14 sitting in the waiting room. Every other hospital in your county is on ambulance diversion, which means you must take the ambulance traffic. Dr. Surgeon wants everything STAT for the appy and Dr. Cardio is taking someone to the cath lab. Now. Ms. Scratchy Throat wants to know how much longer it will be and Mr. Groin Itch wants to leave without being seen. Thank god you are working with Dr. Efficient in the ER, but he’s yelling for the charts you haven’t had time to finish. You have been running for six hours, you haven’t eaten for ten and more than likely you’ll be overtime because someone just called in for the night shift.

In walks Mrs. Mom with her three children, all under the age of four, all of them with fever, all of them to be seen.

You want to scream. You want to pull out your hair. You want to laugh hysterically. You want to burst into tears. You want to yell at the top of your lungs, “NO FREAKIN’ WAY!”
That’s when you start to think of the patient as the enemy…….

Instead, you smile, ask “How can I help you?” while you do quick visual check of all three kids, take down their names and point them to the waiting room to await triage.

Why?

  • Because the patient is NOT the enemy.
  • Because the worst thing you can do to a patient is make them feel stupid, awkward or wrong for showing up.
  • Because it is not their fault that they happened to show up on your weekly “Day of Hell”.
  • Because they may not have the education/background/experience to know what they are dealing with.
  • Because your hospital has spent beaucoup bucks advertising and promoting your facility so that people WILL come in.
  • Because sighing and rolling your eyes is not professional behavior.

There are many opportunities during the patients’ stay in the ER to discuss the fact that they may have had other options. A call to their doctor. An Urgent Care clinic close to where they live. An appointment the next day. I mention this when I discuss the discharge instructions.
I tell patients that, while we are always available, there are ways of accessing health care that are cheaper, easier and often more timely than waiting in an ER.

The key to coming across in a caring way in the middle of “hell-shift” is to smile and focus. Smile at the patient. Focus on them when they are talking. Don’t have one foot out the door while you answer their questions. Be pleasant. Acknowledge that it is busy but that you are there for them.

It isn’t easy when you are tired and frazzled. But I find that just acting this way helps me to feel that way. It makes it a lot easier to get through the shift and your patients really appreciate it.

Because no patient wants to feel like they are the enemy.

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September 28, 2005, 1:17 am

How Do They Manage to Manage?

This is a great shot from an old Wyeth ad. Looks like an early rendition of a triage nurse. She is talking to the woman who rode off with Toto in the Wizard of Oz. She could use a whopping dose of Advil because you just know she is going to have a migraine at the end of the day. I love doing triage. Some people hate it. Some of my most exhausting shifts have been in that triage chair; I would sometimes have 45-50 people cross my desk in 8 hours. Some were easy, clinical issues. The babies always took the most time as they needed weights, rectal temps and, for some crazy administrative reason, measurements of their head circumference. And that’s after you have taken all seven layers off them. Then their socks. Under their booties. In the summer. With a fever. I could write an entire dissertation on the phobia of fever. But I would deal with 100 babies with fever before I would consider doing what I consider the most thankless job in nursing: being the manager of a nursing unit.

Nurse manager. Clinical Coordinator. Head Nurse. Whatever the title, it’s a rough job. They must balance the needs of the nurses and the unit with the orders that come down from Administration. They take the brunt of patient complaints and angry doctors. They are expected to encourage, counsel, dicipline, teach, assess and evaluate their nurses who are taking care of the patients for whom they have the ultimate responsibility. They are expected at meetings, they are expected to hold meetings. They pass along the edicts from Administration and deal with the objections of staff, even if they agree that the change/rule/requirement is needless. They need to be open to staff and allow them to ventilate. They try to balance the personal needs of their staff to the staffing needs of the department, often having to say “no” and then absorb the fallout.

And they are often paid less than the nurses they manage.

I’ve had many managers over the years. Some new, some experienced. Some calm, some hotheads. Some were born to be leaders and some just went through the motions. I actually took a job because I met a manager (and a Critical Care Educator) more enthusiastic about nursing than anyone I had ever met. I had a manager who was as close to super-woman as you could get with three departments at two facilities under her control and they ran like clockwork. There have been managers in small units that would bend over backwards to accomdate every request and managers at teaching hospitals who had so many nurses you were just one of the bunch and whose attitude was “sorry, no-can-do”. I had managers who I could call if the night shift got nuts and managers I only saw every other month.

To most managers I was trouble-free staff and to a few I was their worst nightmare. (Let’s just say God help the manager who has to deal with a nurse going through severe, depressive burnout.) Looking back at my relationships with various managers and now from the vantage point of maturity (I think), I realize what a staff nurse needs to do to help their manager be a good manager:

  • Do your work to the best of your ability. That’s a given. If you are assigned a special project to help with department flow, do it without being reminded. Keep your certifications up-to-date and make sure all appropriate copies are in your file. Keep your timecard correct. Make yours one less thing she has to deal with.
  • Keep in contact with your manager. Sometimes it’s not easy if you work the off-shifts, but check in now and then to say hi. Ask how you’re doing. (This is not the same as your evaluation. Your evaluation should not be the time you find out there is a problem, but often that is the only time you actually sit down with your manager). Have they noticed any areas you could improve? Don’t just assume that because nothing has been said that everything is okay. Oh, and don’t try to do this on the run unless your manager has an open-door policy and is always available. Make an appointment.
  • Managers deal with problems and complaints. Constantly. From all quarters. Don’t have every encounter with your manager be a complaint-a-thon. The one thing you don’t want your manager thinking when they see you is “oh no…..”.
  • Of course there are appropriate times for voicing a dissenting opinion or making a complaint or asking for help with a problem. When meeting with your manager,
    • Have a couple of possible solutions in mind before you go in. You will come across as a problem solver (which you are) and will not come across as, heaven forbid, whining.
    • If you are reporting a problems with a doctor or staff member
      • Try to handle the issue with the person involved before involving your manager. This is not always an easy thing to do, especially if you feel intimidated.
      • Document the problem as best you can. It’s hard for managers to get a handle on issues when they have no data.
  • Finally, let your manager know that they are appreciated from time-to-time. Just a note to thank them for handling your time-card issue or for taking up Dr. Smartmouth’s temper-tantrum with the appropriate department. You get the idea. Yes, it’s their job, but everyone likes positive reminders that their everyday tasks are appreciated.

Boy, there is no way on God’s Green Earth that I would take on a Head Nurse position (I like the term “Head Nurse”. I’m just old fashioned, I guess). I learned early on I don’t have the temperment or the ability to handle that load. But this Indian appreciates a good Chief.

So here’s a tip of my nurse’s cap to the women and men of nursing management who run interference so that my job is easier. Thanks.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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