We have yet to determine if a nurse is just a nurse. I have to say that I recently had another situation happen again with a cardiac patient. This time the patient was my father. He was just recently hospitalized with atrial flutter.

As I mentioned in the previous post, what does a maternity or labor and delivery nurse know about cardiac problems? I want to add now that my mother is also a nurse. She had been a school nurse for almost 30 years. So here we are two nurses who know nothing about atrial flutter and then my father who knew even less than we did.

My Father was hospitalized on Thursday late in the afternoon, and the doctor rounded early on Friday morning. My father did not understand everything that was said to him so he requested that when my mother and I arrived at the hospital we would be able to speak with the doctor. We called the doctor from his room when we got to the hospital. The doctor was very understanding and asked what area of nursing we worked. I believe she asked this so she would know how much we knew about cardiac patients. The doctor explained to us what was going on with his heart and what the plan was for treatment.

In this example, I believe that the doctor did not agree with the statement that a nurse is just a nurse. So why do many hospital administrations believe that a nurse can be floated to any area since we are all nurses? I have had many experiences being floated to areas that I have no experience. Many of my colleagues have had similar experiences. When we try to explain to administration that it is not safe they tell us that a nurse is a nurse.

I ask this question of all the readers. If a nurse is a nurse, how come even doctors don’t agree with that statement? Have you ever been floated to a unit that you are not comfortable working on and if so what happened when you voiced your opinion? Please let me know your feelings about this subject.

I wanted to share the illuminating experience of my month precepting a senior nursing student. My student and I got along wonderfully, which was a very big plus. We worked side by side for every shift the whole month of April, and she saw the reality of nursing in a big way.

The first day my student arrived I was also orienting a newly hired nurse, working short-staffed, carrying a full patient load, and I was charge nurse…in other words, a normal day!  I had her shadow me the first day and did my best to show her around. She asked appropriate questions, showed great initiative, and I learned I could trust her clinical skills and judgement.

The next day I worked with her on some procedures, and by the end of that second 12 hour shift she was prepping medications (with me right next to her of course), interviewing and assessing patients, filling out paperwork, and discharging patients. I was with her the whole time, double checking everything she did and co-signing all the paperwork.

We continued through the rest of our assigned time together and as we worked I did my best to share with her not only the clinical side of nursing but also the emotional side. She watched as a young patient sobbed in my arms, and when we discussed it later, I could tell that my student was affected by the raw emotion expressed by my patient. I explained to her that a patient’s emotional needs are just as important as the physical needs. My student knew this already, but I think that this instance was one of the first times she’d actually seen the concept in action.

Of course it is never always serious. We had a lot of fun with the techs and the other nurses; who would have guessed that there could be so many jokes about C. Diff? (and no, please don’t ask. They are not appropriate for this blog!).

It was a busy month and I learned that it takes a lot of energy to be a preceptor. I explained illness, reasons for the tests that we were doing, and just about everything else. It has underscored for me just how much I love nursing education, and has given me a more solid idea of just how I would like my career to progress over the next few years. The experience also gave me a renewed feeling about nursing; being able to see it from the vantage point of someone who is still brand new helped remind me of how excited I felt when I first graduated. Even though I never really lost that feeling, it was nice re-experiencing it through someone else’s eyes. I completely recommend becoming a preceptor if you have the opportunity.

I pulled this article from Yahoo News this morning.

Dogs helping injured soldiers under gov’t program.

I drove home with your tears still damp on my shoulder
My hair still mussed where you sobbed into it.
A few sneaky tears of my own fell for you
landing on the front of my scrub top.
Poor broken young man
Your heart crying for something you deserve
but didn’t get.
Luck of the draw,
Karma,
whatever…
that doesn’t mean it’s fair.
I gave you 10 minutes of the mothering that
you should have been getting for the last 10 years.
Poor child
I don’t care if you are taller than me
I don’t care if you shave your face daily.
You’re still just a boy and you still feel the hurt.
I said a prayer for you last night, and
another one this morning.
Broken young man,
We can sew up your wounds
but who will mend your heart?

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shared by Paul Nickerson - Paul is not a Nurse, but his Mother, now retired, was for many years. Paul found this poem tucked away in a small photo album belonging to his mother.

Nurse

It was a game we all played as a child
Then some of us made it a dream worthwhile
More to learn, not as much time to share
Because in our hearts we really cared

We have worked the late night hours
While others slept away
Handles a doctor’s many moods
Then found time to pray

Critical moments that remain as memories
Some sad - then some are good
Then there are the tragedies
That will never be understood

We see a newborn baby smile
As we watch another slip away
And that completes the circle
The price for life’s that paid

Sometimes not appreciated
When just a hug will do
We are proud of our profession
A gift from me to you

A nurse is a nurse! I don’t know if I agree with this statement…..do you?

There are many facilities that feel a nurse is a nurse and therefore it is okay to float you to another unit.  I am going to give you a recent example of why I do not believe this statement to be true.

Just remember that I have been a nurse for almost 11 years and have always worked in obstetrics.  The other day at work a patient was transferred to the maternity unit from labor and delivery following a routine repeat cesarean section.  The only significant medical history that she presented with was hypothyroidism, for which she was taking synthroid.  When she arrived on the unit I was on my break from lunch and the nurse covering for me admitted her and did her assessment.

Upon her arrival to the unit the nurse took her vital signs and was surprised to see that her heart rate was 130.  The patient had no complaints and did not feel anything unusual. Being the prudent nurse that she was, she put a pulse oximeter on the patient’s finger to verify that the heart rate was indeed that high.  She was very surprised to see that it was pretty accurate.  However, while she had the pulse oximeter on her patient, she heard a strange sound from the monitor. She said it just didn’t have the same rhythmic sound it usually does when you are listening to a normal rhythm.  She repeated the vital signs at approximately 20 minutes from the initial set.  This time the hear rate was 76.  She kept hearing the strange sound from the pulse oximeter so she called the OB resident to come and evaluate the patient. The resident came and ordered an EKG and some stat blood work.
 
When the EKG was finally done I had no idea what rhythm it was. Part of it looked like sinus tachycardia and then the rest of it I had no idea.  The OB attending came over and looked at it and said he thought it was okay but he was going to call a cardiology consultation.  When the cardiologists arrived they looked at the EKG and almost immediately said she was in atrial fibrillation.  What is that? A big flash back to nursing school came racing to my head.  All I remembered about it was that is was not a shockable rhythm.  The next question that came into my head was what do we do for her?  After all, she is still on the maternity unit and we don’t know anything about cardiac patients.

I have to commend the cardiologists for including me in the discussion about her treatment. I was surprised about that, for the simple reason that the OB doctors at many of the teaching facilities I have worked at never do.  It is as if we aren’t all taking care of the same patients. She opted to be cardioverted the next day instead of taking lopressor, which she wouldn’t be able to breastfeed on and possibly converting over with just medication.  They also began anticoagulating her as soon as possible because of the risk of throwing a clot.

At this point, every nurse on the unit was so nervous about having a “cardiac” patient on the floor. There was so much chatter among the nurses about whether or not she can stay on this unit or not.  The end result was that the cardiologist felt it was safe for her to stay on this unit because we are all nurses.  They felt that she could just stay on the pulse oximeter and she would not have to be on a cardiac monitor, therefore we could keep her.  Lucky us!

Now I am wondering how others feel about this situation. Is a nurse a nurse or have we all become too specialized to care for just anyone?

I am bringing up this topic because of an article I read on the ABC News Health site this morning.

I am a HUGE fan of the Fox TV show ‘House‘ and as I watch the show and actually laugh out loud, I always ponder the question, “Is that really allowed in the healthcare field? Who actually gets away with that???” Now there is a new show on Showtime, ‘Nurse Jackie’, which pretty much follows the same lines as ‘House‘, but with an ER nurse addicted to painkillers instead of a doctor. Now, of course my common sense tells me that no, this is not ALLOWED, however, I bet it does happen more than you would think.

Here is the ABC health news article that I read this morning. It talks about ‘Debbie’, a real nurse working in Michigan, that has actually experienced this ‘roller coaster ride’.  http://abcnews.go.com/Health/PainManagement/story?id=7875858&page=1

Have you ever had an anal patient?  You know the type. They are always looking at the clock and know exactly when standing medications are due, or the exact minute they can have a prn medication. Of course they are on the call bell at that exact minute, saying that they need their medication right now!  I’m sure you know the patients I am talking about, we have all experienced them.  I don’t know how many of you have had the “anal” patient I am about to tell you about.

As you know I am a maternity and labor and delivery nurse.  Last week I had a patient, Mrs. Smith, who refused to go home despite the doctor’s discharge order that was written in the morning on rounds.  I had already assessed her and she was supposed to go home.  She was in the bed by the door and another nurse had the patient by the window.  At about 10:30am when I was writing up the discharge papers for Mrs. Smith, the nurse who had the other patient in the same room as Mrs. Smith came over to me and said, “I think you need to do something for Mrs. Smith”. I asked what had happened and she said that the patient was calling out from the bathroom for help. When she went in to help her she was with her for 20 minutes and all she expelled was a tiny little pebble of a bowel movement.  I went into the room and spoke with Mrs. Smith.
 
Mrs. Smith said she had never experienced the kind of pain she just had in the bathroom, and did not suffer from constipation.  I reminded her that this was the first time she had had a baby and also that she has a third degree laceration which is a tear up to her rectum.  She reiterated that she knew all of that but that none of her friends had told her it was going to be this bad after having a baby.  She then said, “I can’t go home like this.”  I told her I would see what I could do about getting her something for the constipation and also mentioned to her some of the over the counter remedies she could try when she got home.

When I spoke to the resident about the situation, he ordered a glycerin suppository which I administered to Mrs. Smith.  She nearly jumped off the bed when I was giving her the suppository.  I explained to her that it does not provide relief immediately and that it would probably work later that day or that night.  She verbalized understanding but then said she wanted to wait a while to see if she felt any better.
 
After a couple of hours she still said she didn’t feel any better.  I called the OB resident and asked if we could give her milk of magnesia as I explained that the patient was telling me that she couldn’t go home like that.  I told him he needed to come over and see the patient because she would probably feel better hearing exactly what I had already told her, but from a doctor.  He said he would come over as soon as he could but that he was very busy in labor and delivery. She insisted that they couldn’t send her home in that condition because she couldn’t even walk by herself.  She said that  she had to have her husband help her to the bathroom over the last few hours.  I gave her the MOM and then checked on her an hour or so later. She still insisted that she couldn’t go home like that because she was not able to take care of the baby if she couldn’t even walk.  I spoke with her attending doctor who said there was nothing she could do about it, and that they had discussed it that morning, and what she could do when she got home.

I checked on her about two o’clock just before I went to lunch, and she was still lying in the bed on her side.  I assured her that the resident was going to see her as soon as possible.  I also told her that the resident ordered another suppository but that this one was Dulcolax, and I would give it to her before I went to lunch. She refused it saying that “the first suppository hurt way too much and she couldn’t go through that again”. I had the order changed to po and told her that it wouldn’t work as quickly.  She took it gratefully and I went to lunch.

When I returned from lunch and checked on her she said no one had come to see her yet.  She then said that she was a nurse at a nearby hospital in oncology, and that she knew that the last thing the doctor wanted to do is see her for constipation. I was shocked to hear that a nurse was carrying on the way that she had.  She finally decided to leave because she said that since we weren’t doing anything else for her she could go home.
 
I don’t know about you but I would have been embarrassed to admit that I was a nurse after the way she carried on about her constipation.  Well, now you have heard about my most ‘anal’ patient ever.  You have also gotten a taste of the experiences I have had with the OB residents treating the post partum floors as if they are the wicked step children and are unimportant.  There will be more on the nurse/resident relationships in the future.

Becoming a travel nurse was a really good decision for me.  If you read on I am going to tell you how I got started.  I will tell you that it certainly isn’t for everyone, but I have now been doing travel nursing for almost three years and I love it. 

I became a travel nurse for several reasons.  The first reason for becoming a traveler was basically just to leave the job I was currently working at (the large NYC teaching facility mentioned in the previous post).  I knew I had to leave there when I kept volunteering to go home early whenever our census dropped and the staffing office wanted to send someone home.  I was always the first to volunteer.  Many of the times I went home, I didn’t even have any paid time off available and knew I wouldn’t get paid for it.  I also knew that if I stayed there too much longer, I was going to say something to a patient or family member one day that would get me into trouble.  To me, this is a classic sign of burn out.  I just wanted to make people aware of it in case it starts to happen to you.

Another reason I left the NYC hospital job was to be closer to my husband (although we weren’t married at the time).  Since I was always complaining about my job in NY, I mentioned to him one day that I could become a travel nurse and get a job closer to him.  When I explained to him that I would either get a free apartment or money toward my housing expenses if I had a place to stay, he asked me to stay with him.  That question was exactly what I wanted him to ask. What a smart guy he was back then. My thoughts have changed on how smart he is as time goes by….just kidding. 

Over the years I had always been fascinated by travel nursing and always asked many questions to any travelers we had working with us at the time.  I got the feeling that being a travel nurse was like building a vacation into your work life for as long as you were at each location.  I guess that would depend on the location that you worked.  I will tell you now that working in Connecticut is not my idea of a vacation; however it suited my purpose at the time.  While I was living with my boyfriend we got engaged and then married.  I won’t waste time telling you about the proposal because although it is funny this is a nursing blog not a personal one.

So now you have them, my reasons for becoming a travel nurse. I guess my next posting will have to be about some travel nursing experiences.  I look forward to writing them for you.