I often get asked how I deal with the death of a patient. In all honesty, I can't tell you. I just deal with it and move on, I don't do anything in particular. You do sometimes get staff asking if you're ok, but interestingly, recent research has shown that a formal debrief is not helpful, and I've never felt the need for one.
If I've been looking after the patient for a while, especially with lots of family involvement, I do allow myself to get teary. I'm still human after all! I'll even give the family a hug, and let them know by that simple action that I understand, and that I am there to support them through their grief. If necessary, I'll take 5 minutes to myself to process, then it's back to it. It's just part of the territory, and everyone reacts differently.
Having worked in aged care, death has not been a new thing to deal with in this new role. But days like today do test the resolve of anyone. To lose three in one day is rough - no other way to put it - following on from one on the last shift too. It's very emotionally draining. None were unexpected, but it doesn't make it any easier.
It also disturbs your whole plan for the shift. I don't mean this to be selfish or disrespectful, but even one death puts your whole day off, as you have tasks to do with the deceased, not to mention looking out for the family - and they may often spend a good deal of time coming and going to pay their respects. It makes time management difficult, and you often feel like you've been running around all shift with the weight of the world on your shoulders, and the physical tiredness adds to the emotional drain.
Another not so nice thing to have to deal with is bed block. You still have an occupied room that may be desperately needed by someone else. This hasn't happened in this country setting, but with the pressure on hospital beds these days, you can bet there are places who need that person to leave ASAP. Imagine being told you have to leave because someone else is coming in ..........ugh. Awful. I hope I never have to deliver THAT particular piece of news.
I do not regret my choice of career, but boy, there are some really tough days, that's for sure!
Friday, March 25, 2011
Friday, March 18, 2011
The hierarchy issue
Those in the business will understand how a new Registered Nurse can be (legally speaking) higher in the hierarchy than an Enrolled Nurse of 20 or 30 years experience. This is an interesting phenomenon, and one that takes a while to get your head around when you first start. We are used to learning from EN's while on placement, and even as a New Grad, they are a brilliant source of information.
But EN's report to RN's. That's how it works. Time in the job doesn't matter in this instance. While we may still listen to the EN's, and ask their advice or help with something, the ultimate responsibility rests with the RN.
If an EN notices, for example, a patient's obs are in the yellow zone - they go to the RN. In other words, me. Then I get to make the decision on how to proceed. Usually this means reviewing the patient, making a note of the issue, and re-checking the anomalous reading in half an hour or so. I may initiate interventions, such as pain relief, or back to bed for a while, or withhold/give medications. Sometimes it means a phone call to the treating Doctor. Whatever the decision, it is mine to make.
This has caused me some anxiety, as most of the time, the EN will clearly know what to do (and usually do it), and reporting to the RN is just a formality. I may not necessarily know what to do. I'm still a little afraid of getting something really wrong - which I know is silly as there are plenty of experienced staff to help me. I haven't made a wrong decision yet, but it weighs heavily on my mind that a little error or omission on my part could end in disaster for somebody - and then I am up before the Tribunal.
Because the EN has reported to me (and documented this) it then falls on my head. Even if I report to the doctor and they decide not to do anything, it still falls on me, as the RN is the one there with the patient, and it is my job to give the right information for the doctor to make their decision - if I miss something important, it's my fault. If something goes wrong, I am the first line of intervention for that patient. Equally, if I choose not to inform the doctor, it rests with me. Even if I asked the EN for advice and followed it, it's my decision in the eyes of the Coroner.
There are days when I do not think I am cut out for this. It's bloody scary! So much rests on everything we do, and the only person who will protect my registration (and therefore my career) is me. Nobody else - as they will be protecting their own butt. It's a tough lesson to learn, but in health care in today's society, it's every man for himself. We may work as a team, but everyone is always protecting themselves. They have to.
My advice? Something given to me on one of my first days. Whenever you do anything, no matter how innocuous it seems, document. Don't wait for the end of the shift, you'll forget something. And when you do document, imagine the Coroner is reading it. Keep that foremost in your mind - yes, it is frightening, but it sure helps keep my mind on the job!
But EN's report to RN's. That's how it works. Time in the job doesn't matter in this instance. While we may still listen to the EN's, and ask their advice or help with something, the ultimate responsibility rests with the RN.
If an EN notices, for example, a patient's obs are in the yellow zone - they go to the RN. In other words, me. Then I get to make the decision on how to proceed. Usually this means reviewing the patient, making a note of the issue, and re-checking the anomalous reading in half an hour or so. I may initiate interventions, such as pain relief, or back to bed for a while, or withhold/give medications. Sometimes it means a phone call to the treating Doctor. Whatever the decision, it is mine to make.
This has caused me some anxiety, as most of the time, the EN will clearly know what to do (and usually do it), and reporting to the RN is just a formality. I may not necessarily know what to do. I'm still a little afraid of getting something really wrong - which I know is silly as there are plenty of experienced staff to help me. I haven't made a wrong decision yet, but it weighs heavily on my mind that a little error or omission on my part could end in disaster for somebody - and then I am up before the Tribunal.
Because the EN has reported to me (and documented this) it then falls on my head. Even if I report to the doctor and they decide not to do anything, it still falls on me, as the RN is the one there with the patient, and it is my job to give the right information for the doctor to make their decision - if I miss something important, it's my fault. If something goes wrong, I am the first line of intervention for that patient. Equally, if I choose not to inform the doctor, it rests with me. Even if I asked the EN for advice and followed it, it's my decision in the eyes of the Coroner.
There are days when I do not think I am cut out for this. It's bloody scary! So much rests on everything we do, and the only person who will protect my registration (and therefore my career) is me. Nobody else - as they will be protecting their own butt. It's a tough lesson to learn, but in health care in today's society, it's every man for himself. We may work as a team, but everyone is always protecting themselves. They have to.
My advice? Something given to me on one of my first days. Whenever you do anything, no matter how innocuous it seems, document. Don't wait for the end of the shift, you'll forget something. And when you do document, imagine the Coroner is reading it. Keep that foremost in your mind - yes, it is frightening, but it sure helps keep my mind on the job!
Thursday, March 17, 2011
Mmm....chocolate!
Nurses get a lot of chocolate! At least, they do in our hospital! Not a day goes by without a box of chocolates arriving from a grateful patient.....it's a wonder my arse isn't as wide as the state of NSW by now. Naturally I end up sitting closest to the box and everyone knows I have zero willpower when it comes to chocolate......
So when a big fruit basket arrived, we all thought it was such a lovely gift.....(and perhaps the patient's family who sent it thought the nurses were fat enough? Nah, they own the local fruit shop!) We naturally searched further and what did we find? Chocolates hidden at the back! Aaaaaahh..........
So to all the patients out there - yes we LOVE our chocolate! It's about the only gift we are actually allowed to accept :-) Although a nicely worded letter telling everyone what a wonderful nurse I am would go down well too ;-P
Now, for some comedic relief......
In our hospital, on a busy day, once a bed is stripped, it's left for the porter cleaner to remake. Imagine the sight of a big burly bloke, who has never made a bed before, trying to wrestle our tiny little sheets over a big air mattress........classic!
So when a big fruit basket arrived, we all thought it was such a lovely gift.....(and perhaps the patient's family who sent it thought the nurses were fat enough? Nah, they own the local fruit shop!) We naturally searched further and what did we find? Chocolates hidden at the back! Aaaaaahh..........
So to all the patients out there - yes we LOVE our chocolate! It's about the only gift we are actually allowed to accept :-) Although a nicely worded letter telling everyone what a wonderful nurse I am would go down well too ;-P
Now, for some comedic relief......
In our hospital, on a busy day, once a bed is stripped, it's left for the porter cleaner to remake. Imagine the sight of a big burly bloke, who has never made a bed before, trying to wrestle our tiny little sheets over a big air mattress........classic!
Saturday, March 5, 2011
I was reading about bullying in nursing, and came across this blog by Phil Baumann on Health is Social. It hits in on the head, for me anyway. Some people take nursing, and themselves, far too seriously.
Most of us have heard the term "nurses eat their young," and it's a rare student or graduate that hasn't experienced it at some point. I certainly have! And on the other hand, you often see nurses joking and laughing at work, which some people see as inappropriate. Many people believe that nurses need to be "serious" as nursing is a "serious" business.
Without a sense of humour, a nurse would quickly become sour. I could not do this without being able to share a laugh or joke with my colleagues. You certainly cannot make jokes about a patient or their condition, as this would be completely inappropriate, but to have a laugh with your colleagues is, in my humble opinion, imperative to keeping your sanity in a tough profession. Many patients also like having a laugh with you, although you do need to remember that you are representing your employer, and nursing as a profession, when you interact with your patients. Keep it appropriate!
As Phil says, being "serious" is not the same as being "responsible," and it is the latter that is important for nurses. Being serious is emotional and personal - being responsible is to do with assessing, understanding, and taking the right actions. Serious = create anger and blame, responsible = find a solution.
I brought this up because I too am experiencing bullying. Not just at myself, but at a patient. And this is totally unacceptable and unprofessional. I'm not going to relate the entire incident, but would just like to say that a patient's comfort is always of high priority in nursing care. Just because the nurse thinks something should, or should not, be done, is not the key here - if the patient requests something in their own care plan (that is not unreasonable) and is documented to be done, then it should be done. One nurse does not have the authority to arbitrarily change something and then tell the patient that too bad, this is how it is. Consultation and respect are required, especially when the patient clearly tells you that changing things would make them uncomfortable. To not be allowed to speak on their own behalf is belittling! In this instance, the current regime was working, however the nurse wanted to change the care plan. They felt that the current strategy was impairing healing, however to do so would cause discomfort and distress to the patient. While it may have been of better clinical value, the stress and discomfort caused may well negate that value. The patient clearly made their wishes known at all times.
Never forget your patient (or your colleague, or your student) is a person. They have feelings too.
And don't take yourself too seriously. :-)
Most of us have heard the term "nurses eat their young," and it's a rare student or graduate that hasn't experienced it at some point. I certainly have! And on the other hand, you often see nurses joking and laughing at work, which some people see as inappropriate. Many people believe that nurses need to be "serious" as nursing is a "serious" business.
Without a sense of humour, a nurse would quickly become sour. I could not do this without being able to share a laugh or joke with my colleagues. You certainly cannot make jokes about a patient or their condition, as this would be completely inappropriate, but to have a laugh with your colleagues is, in my humble opinion, imperative to keeping your sanity in a tough profession. Many patients also like having a laugh with you, although you do need to remember that you are representing your employer, and nursing as a profession, when you interact with your patients. Keep it appropriate!
As Phil says, being "serious" is not the same as being "responsible," and it is the latter that is important for nurses. Being serious is emotional and personal - being responsible is to do with assessing, understanding, and taking the right actions. Serious = create anger and blame, responsible = find a solution.
I brought this up because I too am experiencing bullying. Not just at myself, but at a patient. And this is totally unacceptable and unprofessional. I'm not going to relate the entire incident, but would just like to say that a patient's comfort is always of high priority in nursing care. Just because the nurse thinks something should, or should not, be done, is not the key here - if the patient requests something in their own care plan (that is not unreasonable) and is documented to be done, then it should be done. One nurse does not have the authority to arbitrarily change something and then tell the patient that too bad, this is how it is. Consultation and respect are required, especially when the patient clearly tells you that changing things would make them uncomfortable. To not be allowed to speak on their own behalf is belittling! In this instance, the current regime was working, however the nurse wanted to change the care plan. They felt that the current strategy was impairing healing, however to do so would cause discomfort and distress to the patient. While it may have been of better clinical value, the stress and discomfort caused may well negate that value. The patient clearly made their wishes known at all times.
Never forget your patient (or your colleague, or your student) is a person. They have feelings too.
And don't take yourself too seriously. :-)
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