Wednesday, April 13, 2011

Just what is on our shoulders.......

Thinking about a post on impactEDnurse.com made me wonder - do people really understand what it is a nurse does, and what the implications of our job are? Do they see us as bum-wipers and vomit-catchers, or do they see us a the professionals we would like them to see? Do today's nurses display the professionalism expected of us? Do we still appear to be the "doctor's handmaiden" or are we showing the world that we are a profession of our own?

Some days I wonder.


I handed over recently that a particular patient would need to be turned later in the night. The other nurse replied "oh, he can turn himself." This shocked me a bit. The reason the patient was there was because he was unwell (der!) and to be judged as able to turn himself, without this nurse ever laying eyes on him, is completely unprofessional. If he were to develop a pressure area, where would this nurse stand if she had not turned him - and documented that he'd been turned? Not to mention the pain that may be caused by staying in one position for too long.


We had an awful arrest just last night, which will be a Coroner's death, and probably the first that actually shook me up a bit. While it's very sad, foremost in our minds now, is thinking back over things and wondering if we did everything right. A mistake could mean a visit to the Tribunal, de-registration.....or worse. A split second decision can mean far more than a simple correction in the notes! An accountant makes a mistake, he can just recalculate and it's fixed. A nurse makes a mistake - someone may die, and that nurse's life will be forever impacted by that mistake - not to mention the family of the deceased.

It's appropriate that the last 2 days I've had a student EN with me and was talking about documentation (and therefore covering your own butt!) with her. Sometimes it takes something like last night to bring it home to students and new grads just what their registration means, and how easily it can be lost.
 How nice it would be if nurses could "just nurse" - without all the complications! But then, I think we'd still have the same attitudes, the same bullying, and the same doubtful practices we see now - probably worse. Accountability is here to stay, for good reason, but boy does it complicate things! And really what does "just nurse" actually mean?

How to educate the public on a modern nurse's role? I have no idea. But every one of us must remember that to be accepted as more than "handmaidens," we need to be people of integrity, showing professionalism in all that we do, showing the world that we do possess knowledge of our own, can think independently, and be responsible for ourselves.

But don't forget the basic, fundamental nursing care along the way. It's the little things that make the difference between a nurse and a GREAT nurse - the one the patients remember long after they go home.



Friday, April 1, 2011

Slowly but surely.....

So it's now 2 months down the track......and I think I am starting to get the hang of things. It took a flat out, scary day such as today to tell me that yes, I do know what I'm doing, and I think the trust in me from both myself and others is increasing.



Today was just flat out. We are on "critical beds" - in other words, there is not an empty bed in the place. We are full. I spent most of my shift looking after a very sick patient in our High Dependency room - something I could not have imagined doing just a few short weeks ago. I'd been told on my first day or two that I wouldn't have to look after that room yet, so it was a bit daunting to say the least. Add to that, the patient's family were getting rather upset that he hadn't been transferred out despite our best efforts. I wish I could just send them all where they needed to be immediately, but unfortunately we cannot create beds out of thin air, even in major hospitals! Not even for private patients - I'm sorry people but a private health fund doesn't give you preferential care, it's still on a needs basis. The sickest people are seen first, that's how it works.



The other RN, being the midwife, spent the entire shift in maternity as it was also full and there was a lady in labour, so here was I, thrust into a full on RN role whether I liked it or not. The buck stopped with me - I had to look after this very sick patient, plus the other 20-odd patients with the help of the EN (who was wonderful I must say!). We called in another RN to help, but even so, it really was flat out. It seemed that every time I went to do something, someone would ask me a question, or need S8 drugs from the locked cupboard, or need their IV antibiotics, or their cannula was leaking - those small but necessary tasks designed to divert your attention!



Last week was one of those weeks where I doubted my ability to do this job. Just a lot of niggly little things, where it seemed that nothing was ever easy, lots of those days that erode your confidence without you even noticing. Today freaked me out when I realised what was on my shoulders. But the only thing to do is get your head down and bum up and do the job you trained for - and remember that you are only human and must prioritise your tasks. A patient won't be really inconvenienced if they miss out on a shower today, but if you miss their pain relief, that's a problem. There were some hiccups during the day, but overall it went well, despite our limitations! The hardest part was not letting the sick patient's family see how nervous I was in that room. I think I should be nominated for an Oscar after that performance!

Pic: Ambulance Service of NSW
My sick patient was successfully transferred to the major tertiary centre via air ambulance at the end of the shift, and was also the first transfer I handled completely myself. I spent the whole shift freaking out that if something went wrong with this person, I would not know what to do, so the paranoia is not gone yet, but today has certainly proven to me that I can do this job. Whether my resolve stays this certain tomorrow, who knows!