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fredericksI worked as a registered nurse on a medical-surgical floor, with the emphasis squarely on the medicine side of things and the unspoken specialty in patients with gastrointestinal (GI) issues (btw “the floor” is the vernacular for “hospital floor”; the ICU [intensive care unit] is usually referred to as “the unit”). This meant that we only rarely got post-operation patients: patients post gallbladder surgery (the medical term being cholecystectomy) and PEG (Percutaneous Endoscopic Gastrostomy – a tube is placed directly from the stomach leading out through the abdominal wall in order to allow feeding) placement would tend to return to the floor post-surgery, as well as the occasional hip fracture patient post ORIF (Open Reduction-Internal Fixation – meaning they required surgeons to place hardware for their hip to be fixed). All other patients would either be directly admitted to one of the surgical floors or would be transferred to a surgical floor after their procedure.
Because we got a lot of GI cases we tended to see tons of patients with diverticulitis, colitis, Crohns, and GI bleeds. I literally dealt in a lot of shit: you have to test for various parasites, viruses, and bacteria when patients present with GI symptoms, and that meant collecting feces in various tubes and containers. It also meant lots of bowel preps, which is okay if you have a stable ambulatory patient but not so okay if you have a patient who’s bed bound or (even worse) a patient presenting with GI bleed who wants to be ambulatory but is ordered to be on bed rest, as bleeding can lead to a drastic decrease in blood pressure and oxygen circulation, which in turn can lead to lightheadedness, fainting, and a bunch of other non-delightful stuff. I much prefer cleaning up sheets every half-hour or so to having to call a Code and/or the Rapid Response Team.
That’s another thing: being a nurse requires an engagement of all the senses. When all those bowel preps kick in you’re in for a cacophony of odors. You quickly become an expert in differentiating between the patient with a mild case of food poisoning and the patient with c.difficile. You never forget the smell of c.diff. You also never forget the smell of an evacuating patient with an active GI bleed. Patients would come in with stage III and IV pressure ulcers (formerly known as bed sores, pressure ulcers are scaled from I to IV, with a I being equivalent to a blister and a IV being a wound going all the way through muscle with bone visible. Go on and Google images for “Stage IV pressure ulcers”. Go on. Don’t be a punk, now.) and we’d have to treat and dress them once or twice a day. Dead and dying tissue stinks (I hear the “duh”, but it needs to be said). The level and type of odor is used for classification and assessment.
You use sight for doing assessments of patients and their environment. Nowadays we have tons of diagnostic tools at our disposal, both invasive and not, but oftentimes the best ones are our own damn eyes. For example: you lightly press a patient’s abdomen and he or she winces, then replies it didn’t hurt. You don’t note the patient has no pain, but exactly what you did and exactly what the patient said and did. When a patient was admitted to the floor and I went through his or her belongings in order to list it all on a patient property sheet, I took note of the cleanliness of what was there. The patient’s grooming and hygiene was also important, because it told me what resources the patient had at his or her disposal and in what ways I could help him or her while he or she was on the floor (a meeting with a dietician, social work follow-up, a wound care consult, requesting the primary physician put in for a podiatry consult, etc), as well as lending background to what may have factored into the reason for his/her hospital visit. At the most basic level reading of charts and flow sheets was important for incorporating the current course of care and the patient’s response (vital signs, blood glucose, electrolytes, blood cell counts, etc). My facility was in the early stages of converting to computerized charting, so lab work and certain orders were on the computer while everything else was kept in patient binders.
Luckily we’ve move past the point where taste is used as a diagnostic tool on the floor (technology rocks), but it is important to make things palatable for patients so they can get it down, and I’m not just talking about medicine. Food and proper nutrition are the building blocks of the body. If the body isn’t getting enough fuel healing isn’t going to occur, no matter how much time and money and energy is spent on replacing organs or fixing tears or what have you. You really are what you eat, and it’s important that you eat properly to keep things running, especially if you’re in the hospital. So we make sure patients are getting something to eat that’s within their dietary parameters and that they like. And then we emphasize the importance of eating.
Audition is used, for one, when auscultating various body sounds (a good stethoscope is your friend). Listening to the heart and lungs is very important, particularly if you have a patient with congestive heart failure (CHF), respiratory issues, or problems swallowing. Bowel activity is also important, for patients post-anesthesia and anyone admitted with GI issues. Touch is great for when one’s looking for veins or palpating, as mentioned above. You also check skin and other parts of the body to make sure things are looking okay (self breast and testicular exams are our friends, people). Treatment is a holistic thing, with the mental going right along with the physical and hearing and touch factor in when it comes to simply being a caring human being as well. You have the things you can hear without equipment, like what the patient says. What is or isn’t coming out of a person’s mouth is significant and shouldn’t be taken for granted. And never underestimate the power a hand on a person’s shoulder or a hug can have on healing. A nurse is there when people are at their most emotionally fragile point. I’ve been present when families have cried after the passing of a loved one, I’ve wiped away tears when a patient attempted to comprehend a dire diagnosis, I’ve held hands and rubbed backs while quiet souls have described living in constant pain, I’ve rejoiced with strangers when they’d been informed they’d been given the all clear…it’s simultaneously draining and fulfilling.
As I hinted to in the above, there’s a lot to nursing and being a nurse. We were fortunate to have unlicensed auxiliary staff to lend a hand. In my hospital we had nurse’s aides, orderlies, and floor secretaries. Nurse’s aides took care of most phlebotomy work, feeding patients, cleaning patients, and taking patient’s vitals. Orderlies were there to get any supplies that were required that weren’t located on the floor, transport patients, and help with lifting and ambulating patients as needed. Secretaries “picked up” orders placed in patient charts (which involved scanning medicine orders to the pharmacy so the meds could be sent up, transcribing orders to patient’s medicine administration report so nurses knew what they had to administer, entering relevant labwork/diagnostic procedure in a computer) and organized patient paperwork. All of these unlicensed personnel were on-hand to assist the nurse in his or her duties as delegated, and by law the nurse is responsible for their actions (read that last part again and tell me it doesn’t sort of suck). Some auxiliary staff worked harder than others, and it really could really hamper your day if your aide suddenly decided he was “too busy” to answer call bells while you were attempting to tend to a more critical patient or the secretary spent so much time IMing that she didn’t pick up your patient’s transfusion order until three hours after the fact. And a nurse could and does end up doing many of the tasks designated for auxiliary staff, when the staff’s not on hand or if the staff has decided to drop the ball. One of the first things my preceptor told me was to do as much of my own care as possible, and it helped tons (the auxiliary staff on my floor got away with a hell of a lot; management was entirely too lax when it came to taking nurse’s concerns seriously). Good help was always a blessing.
Since I’m on my soapbox I might as well address a couple of misconceptions that have been perpetrated by popular media (ER I’m looking at you): in hospitals doctors are not nurse’s bosses. There’s a very distinct nursing hierarchy, which was head in our hospital by the Chief Nursing Executive. A physician cannot directly fire a nurse. If a physician had an order he or she wanted carried out and the nurse was not comfortable with it for whatever reason, the nurse could appeal to his or her higher up (or ask a colleague to do the task, if that’s what it came down to). This is not to say that doctors aren’t blatantly catered to by hospital administration. Nurses are staff, while physicians (this excludes residents and interns) are considered favored clients. Doctors bring their patients to the hospital, and this in turn brings in the revenue. I do think it’s slowly starting to sink in that nurses and nursing staff, in fact, are a key factor in patient’s satisfaction with in-hospital care, but nursing care is still bundled in with housekeeping charges when it comes down to the bill, whereas each bit of care by a physician can be charged separately; money talks. A second misconception is that physicians can run a hospital by themselves. Nurses outnumber physicians by outrageous numbers at hospitals, although one would never think as much by looking at primetime medical shows.
Along with the unlicensed auxiliary we also worked with respiratory therapists, nurse practitioners, and physician assistants. Our floor also used to be “covered”, meaning it was designated a teaching floor and was populated by patients who’d be taken care of by residents and interns overseen by an attending physician. After we moved from a covered floor to an NP floor (if we had any issues with patients we were to contact nurse practitioners) I realized that covered patients tended to be the “heavier” patients, meaning they had more chronic health issues that made for a more complicated case and, thus, a better learning experience for the new medical folk.
And I'm stopping there because that took me a long time to type up. Part II (aka "A Day in the Night of a Nurse") coming soon.
Because we got a lot of GI cases we tended to see tons of patients with diverticulitis, colitis, Crohns, and GI bleeds. I literally dealt in a lot of shit: you have to test for various parasites, viruses, and bacteria when patients present with GI symptoms, and that meant collecting feces in various tubes and containers. It also meant lots of bowel preps, which is okay if you have a stable ambulatory patient but not so okay if you have a patient who’s bed bound or (even worse) a patient presenting with GI bleed who wants to be ambulatory but is ordered to be on bed rest, as bleeding can lead to a drastic decrease in blood pressure and oxygen circulation, which in turn can lead to lightheadedness, fainting, and a bunch of other non-delightful stuff. I much prefer cleaning up sheets every half-hour or so to having to call a Code and/or the Rapid Response Team.
That’s another thing: being a nurse requires an engagement of all the senses. When all those bowel preps kick in you’re in for a cacophony of odors. You quickly become an expert in differentiating between the patient with a mild case of food poisoning and the patient with c.difficile. You never forget the smell of c.diff. You also never forget the smell of an evacuating patient with an active GI bleed. Patients would come in with stage III and IV pressure ulcers (formerly known as bed sores, pressure ulcers are scaled from I to IV, with a I being equivalent to a blister and a IV being a wound going all the way through muscle with bone visible. Go on and Google images for “Stage IV pressure ulcers”. Go on. Don’t be a punk, now.) and we’d have to treat and dress them once or twice a day. Dead and dying tissue stinks (I hear the “duh”, but it needs to be said). The level and type of odor is used for classification and assessment.
You use sight for doing assessments of patients and their environment. Nowadays we have tons of diagnostic tools at our disposal, both invasive and not, but oftentimes the best ones are our own damn eyes. For example: you lightly press a patient’s abdomen and he or she winces, then replies it didn’t hurt. You don’t note the patient has no pain, but exactly what you did and exactly what the patient said and did. When a patient was admitted to the floor and I went through his or her belongings in order to list it all on a patient property sheet, I took note of the cleanliness of what was there. The patient’s grooming and hygiene was also important, because it told me what resources the patient had at his or her disposal and in what ways I could help him or her while he or she was on the floor (a meeting with a dietician, social work follow-up, a wound care consult, requesting the primary physician put in for a podiatry consult, etc), as well as lending background to what may have factored into the reason for his/her hospital visit. At the most basic level reading of charts and flow sheets was important for incorporating the current course of care and the patient’s response (vital signs, blood glucose, electrolytes, blood cell counts, etc). My facility was in the early stages of converting to computerized charting, so lab work and certain orders were on the computer while everything else was kept in patient binders.
Luckily we’ve move past the point where taste is used as a diagnostic tool on the floor (technology rocks), but it is important to make things palatable for patients so they can get it down, and I’m not just talking about medicine. Food and proper nutrition are the building blocks of the body. If the body isn’t getting enough fuel healing isn’t going to occur, no matter how much time and money and energy is spent on replacing organs or fixing tears or what have you. You really are what you eat, and it’s important that you eat properly to keep things running, especially if you’re in the hospital. So we make sure patients are getting something to eat that’s within their dietary parameters and that they like. And then we emphasize the importance of eating.
Audition is used, for one, when auscultating various body sounds (a good stethoscope is your friend). Listening to the heart and lungs is very important, particularly if you have a patient with congestive heart failure (CHF), respiratory issues, or problems swallowing. Bowel activity is also important, for patients post-anesthesia and anyone admitted with GI issues. Touch is great for when one’s looking for veins or palpating, as mentioned above. You also check skin and other parts of the body to make sure things are looking okay (self breast and testicular exams are our friends, people). Treatment is a holistic thing, with the mental going right along with the physical and hearing and touch factor in when it comes to simply being a caring human being as well. You have the things you can hear without equipment, like what the patient says. What is or isn’t coming out of a person’s mouth is significant and shouldn’t be taken for granted. And never underestimate the power a hand on a person’s shoulder or a hug can have on healing. A nurse is there when people are at their most emotionally fragile point. I’ve been present when families have cried after the passing of a loved one, I’ve wiped away tears when a patient attempted to comprehend a dire diagnosis, I’ve held hands and rubbed backs while quiet souls have described living in constant pain, I’ve rejoiced with strangers when they’d been informed they’d been given the all clear…it’s simultaneously draining and fulfilling.
As I hinted to in the above, there’s a lot to nursing and being a nurse. We were fortunate to have unlicensed auxiliary staff to lend a hand. In my hospital we had nurse’s aides, orderlies, and floor secretaries. Nurse’s aides took care of most phlebotomy work, feeding patients, cleaning patients, and taking patient’s vitals. Orderlies were there to get any supplies that were required that weren’t located on the floor, transport patients, and help with lifting and ambulating patients as needed. Secretaries “picked up” orders placed in patient charts (which involved scanning medicine orders to the pharmacy so the meds could be sent up, transcribing orders to patient’s medicine administration report so nurses knew what they had to administer, entering relevant labwork/diagnostic procedure in a computer) and organized patient paperwork. All of these unlicensed personnel were on-hand to assist the nurse in his or her duties as delegated, and by law the nurse is responsible for their actions (read that last part again and tell me it doesn’t sort of suck). Some auxiliary staff worked harder than others, and it really could really hamper your day if your aide suddenly decided he was “too busy” to answer call bells while you were attempting to tend to a more critical patient or the secretary spent so much time IMing that she didn’t pick up your patient’s transfusion order until three hours after the fact. And a nurse could and does end up doing many of the tasks designated for auxiliary staff, when the staff’s not on hand or if the staff has decided to drop the ball. One of the first things my preceptor told me was to do as much of my own care as possible, and it helped tons (the auxiliary staff on my floor got away with a hell of a lot; management was entirely too lax when it came to taking nurse’s concerns seriously). Good help was always a blessing.
Since I’m on my soapbox I might as well address a couple of misconceptions that have been perpetrated by popular media (ER I’m looking at you): in hospitals doctors are not nurse’s bosses. There’s a very distinct nursing hierarchy, which was head in our hospital by the Chief Nursing Executive. A physician cannot directly fire a nurse. If a physician had an order he or she wanted carried out and the nurse was not comfortable with it for whatever reason, the nurse could appeal to his or her higher up (or ask a colleague to do the task, if that’s what it came down to). This is not to say that doctors aren’t blatantly catered to by hospital administration. Nurses are staff, while physicians (this excludes residents and interns) are considered favored clients. Doctors bring their patients to the hospital, and this in turn brings in the revenue. I do think it’s slowly starting to sink in that nurses and nursing staff, in fact, are a key factor in patient’s satisfaction with in-hospital care, but nursing care is still bundled in with housekeeping charges when it comes down to the bill, whereas each bit of care by a physician can be charged separately; money talks. A second misconception is that physicians can run a hospital by themselves. Nurses outnumber physicians by outrageous numbers at hospitals, although one would never think as much by looking at primetime medical shows.
Along with the unlicensed auxiliary we also worked with respiratory therapists, nurse practitioners, and physician assistants. Our floor also used to be “covered”, meaning it was designated a teaching floor and was populated by patients who’d be taken care of by residents and interns overseen by an attending physician. After we moved from a covered floor to an NP floor (if we had any issues with patients we were to contact nurse practitioners) I realized that covered patients tended to be the “heavier” patients, meaning they had more chronic health issues that made for a more complicated case and, thus, a better learning experience for the new medical folk.
And I'm stopping there because that took me a long time to type up. Part II (aka "A Day in the Night of a Nurse") coming soon.
