People come in to the ED for so many reasons. We get people who are in physical pain and need treatment, but we also get people in emotional and spiritual pain as well; often the three overlap.

The patients who apparently seem to come in for their next ‘fix’ are seen as drug-seekers by many, and the underlying pain is often times so well-masked by the addiction that takes a conscious effort to find the real source. People come in demanding this-or-that narcotic in this-or-that dose, and are immediately thought of as having ’seeking behaviors’, This may or may not be true; what we under-treat in health care is the deeper reason that the person has the need for the drug. Deeper than the addiction, we miss the root source of the addictive behavior.

One can argue that in the Emergency Room, we just don’t have time to delve into the psycho-social issues behind a patient’s problems, and that is a very true and valid point. But in my own practice as a Registered Nurse, my goal is to at least try to understand the patient, to see behind the barriers they have erected (often to shield them from the judgments that are made against them) and to find the person within–the person behind the addiction. That is when I feel that the true treatment begins. Validating a person who is seen by many as a label, and giving that person a real chance at human kindness, is what makes me feel like I’ve made a difference. Even if it’s a turkey sandwich or a glass of juice, it’s that human connection that is needed most by these types of patients.

I have a hard time when a person is judged and labeled a seeker even before he or she has been seen by a provider. There are real pain conditions that don’t show up easily on lab tests, and there are real pains that are unexplainable. I have a hard time when I hear a provider say something along the lines of “Oh yeah, fibromyalgia and depression. Probably just looking for narcs.”

Pain is pain; that’s nursing 101. I believe my patients have pain, no matter if they have a diagnosed medical condition or not. I just wish that others would see that the pain doesn’t always have to be quantified, and that it doesn’t always have a root in the physical body.

We owe it to our patients to see beyond what appears to be drug seeking behavior, and to find that essence of humanity in each and every person that we are privileged to care for. I am not saying that there aren’t people who use the ED as a place to get a fix; that most certainly does happen. But even with the people who come in with demands and dosages deserve our best care. In fact, I could argue these are the people who need us most, because their pain is so extreme that they are using physical means to block it.

Just something to think about, as you go about your practice as a nurse…

Dear Nursenakia,

You are the winner for last months Joke of the Month contest, however we have not been able to reach you to mail you your prize ($20 Gift Certificate to Nurses Station).

Please email us your mailing address, or call our customer service line at 800-234-1024.

To all Contestants: Nurses Station Blog emails winning contestants from customerservice {at} nursesdirect(.)com . We will need a reply with your mailing address so that we can send prizes. If you prefer- you can check the Nurses Station Blog regularly to see if you have won- Winning jokes are posted along with the name of the winner. Should your name and joke be posted as the winner, be sure to email us or call 800-234-1024.

W

I wrote the poem below after my daughter had been very sick and spent several scary days in the PICU. I was only 6 weeks into my first semester of the nursing program, and ultimately had to withdraw that semester and restart again at the beginning of the next one.

The poem illustrates how I felt as I waited alone outside the CT scan room door. Every once in awhile I pull it out and revisit how it felt to be on the other side of the exam table, and to help me remember the feelings that my patients are experiencing:

TRANSPARENT BOX
I sat in the hallway in my transparent box,
Hard plastic chair digging into my thighs.
I watched them walk by from my seat in the corner,
Saw their eyes gaze just past me as I started to cry.

Important people surely with lives to be saved,
lab test and requisitions and orders for meds.
Yet I sat there invisible in my transparent box,
Did they realize my baby was in one of their beds?

Oh sure, one kind-of smiled and one sort-of nodded,
hurrying past the hallway where I waited in fear.
Stethoscopes swinging and lab coats like badges;
They can deal with diagnoses but were blind to my tears.

So I sat clutching my shoulders, trying in vain
To reassure myself they were wrong, and it’s only a test.
Shivering, shaking, my world falling to pieces
While they bustled on past me doing their best
      To look beyond me in my transparent box
      Where I found no doors, no windows, no locks
      No sympathetic ear to commiserate or heal
      No simple words to confirm what I feel
Just me all alone… in my transparent box.

Here is our winning joke for the month of June;

My daughter asked me ” Mommy do you get to sit at work?” I said yeah, ” she said where?” I said @ the nurses station, she said, ” Do they sell gas there?” I said no the gas there is free

Our Winner, nursenakia, will be receiving a $20 gift certificate from Nurse Station Catalog!

Submit a joke yourself, tell a friend, tell your colleagues! Winners are selected the 15th of the following month, and are contacted via e-mail for a mailing address to receive their prize.

(Please note, only G-rated jokes will be published and eligable for the contest)

It just never gets easier. Every situation is different, but every outcome the same.

I hate those stupid surveys that float around email that always ask “Have you ever seen a dead person”

Actually, I have, and I have seen more than I wish. It’s not some thrilling bit of info for an asinine survey. It’s a real event, with real people and real emotions.
You want to know what it’s  REALLY like? Think of this:

The family is sobbing in the hallway while the person to whom you spoke a day ago is now a discarded shell, the actual person having escaped to places Other.

The feeling of shutting off an IV and taking out the IV catheter from a vein that does not have any blood pressure.

The sound of the “death rattle” when the dying person loses their gag reflex.

The feeling of utter helplessness when you know you can’t do anything to make anyone feel better.

The fleeting feeling of fear when you give the dying person just a little more morphine because even though they are non-verbal, they are grimacing, and the hope that you didn’t give enough to kill them but just enough to comfort them. While at the same time the rational thought that even if you DID give them enough to suppress their respirations, your INTENT is to provide pain relief, and therefore you did nothing wrong so you give the morphine.

The sound of the shroud when you unfold it from the bag.

The fear in the families faces when they come to say “I think you’d better come….” and can’t finish the sentence.

The sadness in your own voice when you tell them that you cannot hear their loved one’s heart beat, and that you cannot hear their loved one breathing.

The difficulty in watching other grownups cry.

Having to call a doc and say “I need you to come pronounce my patient”
The heavy feeling of walking into the supply room and getting out the morgue kit.

After all their pain…all their tears….they thank you.  The family who loses a cherished loved one thanks you.

You go home, and hug your children and cuddle up to your spouse, trying not to remember the sounds of grief that echoed down the hallway as you punched out and left work.

My husband sent me an email yesterday with an excited “Check this out!” in the subject line. I clicked on the link and it was pictures of contemporary nurses, working and wearing nurse’s caps. Apparently my husband thought (as had I) that the wearing of caps in the workplace had died out some time ago.

It made me think about not only caps, but uniforms in general. Back when I was in nursing school the first time, our uniform was an uncomfortable and unforgiving white dress with a blue-edged pinafore. White hose only, and proper nursing shoes. I remember when I put that scratchy thing on, I felt like an imposter—like I was playing dress up in someone else’s clothes. But when we started our clinicals, I saw lots of nurses wearing the traditional white dress and I thought, “Ok, that’s how it goes I guess.”

Fast forward almost 20 years when I entered nursing school again. This time, our uniforms were white scrub pants, white scrub tops, and sensible nursing shoes. Still no caps, of which I was glad, but also no more dresses. It’s amazing how easy it was to bend, move, and lift wearing the nice, baggy scrub pants the school was now allowing. And while all the nurses I saw were in scrub pants and not in dresses, I could count on one hand how many actually wore white. Instead, scrubs have bloomed into lots of different colors and patterns.

After graduation, people joked that they would burn their nursing school scrubs. They wanted the freedom to choose their own clothes, and to step away from the white which in many minds during school, came to symbolize ‘student’ rather than ‘nurse.’
I guess I am different because I kept my scrub uniform, and wore it until there were one too many stains on it to justify its continued use. Even now, I wear white pants almost exclusively at work, and my tops are generally solid color and low-key.
Local hospitals have been establishing dress codes recently, in order to better allow the patient to understand who is the nurse and who is, say, the environmental service provider, seeing as everyone wears scrubs. So far my hospital isn’t quite on the bandwagon yet, although there was a pilot involving the colors white, black, and khaki. Now, however, we are just wearing really big badge clips with RN or LPN on them, and that seems to suffice.

I personally feel that the color white is associated with medicine, and that we should take ownership of it. Doctors, NP’s, PA’s, Residents…they all have white lab coats. Nurses are the only medical professionals who are traditionally associated with white pants. Sure its hard to keep clean, and sure they get dirty easy—but that’s why they are scrubs and that’s why they are inexpensive and budget friendly.
Me, I will be in whites until the day I retire. I’m even thinking of buying a cap, just for fun.

Scrubs at Nurses Station