5 Things I’d Like To Tell My Patients

I think you all have an idea of what I’m talking about, whether you’re a nurse, a CNA, a student, or even an employee of one or your hospital’s ancillary departments. There are always those things, the things you wish you could say to your patients that would be taken as respectfully as you intend them to be. The things that as healthcare workers we experience every day, but know our patients have no idea just the burden that it places on us when these seemingly insignificant actions are put into play.

A few weeks ago, I asked the question of If you could say anything to your patients, what would it be and it was met with an amazing response. Many of your ideas had me laughing and nodding in agreement. So without further ado, here are five of what I considered to be the most universally applicable responses:  

1. When you use your call light, please tell me why you are calling. This is huge, and when it comes down to it, it will save you and I both some time. While “I need help” or “I need my nurse” will get you a response, it is incredibly helpful to know what I will be walking in to. Do I need to come personally, or can I send a CNA if I am tied up? Are you having shortness of breath or chest pain that would necessitate me dropping everything I am currently doing with another patient, or do I need to swing by your room to deliver some nausea medicine as my next stop? If it’s just another can of Coke you want, let me know so I can grab it on my way down to your room instead of having to make another trip.

2. Please, put your cell phone down. This isn’t airport security, or the DMV, but I would appreciate the respect of putting your phone down when I am trying to ask you questions. If you feel up to it, talk all you want on your own time, but I am here to be your nurse, not your personal attendant. To “come back later” puts me at a serious inconvenience when I’m trying to juggle the care of anywhere between two and seven patients. I understand that emergencies come up, and you may need to pick up your phone to quickly reassure your loved one who may panic if you don’t answer that everything is okay, but please, please, please don’t use med pass and assessment time as an opportunity to engage in a catch-up chat with your long lost cousin who wants to make amends now that she found out you’re having a health scare. Just call them back.

3. Do you really understand what 10/10 pain truly means? I don’t doubt you are hurting. I can see it in your vital signs. I can see it in the grimace on your face as you try to get comfortable in a hospital bed that is anything but. I can see it in the bumps and bruises and incisions that mark your body. I understand that pain is subjective, and if you’re one of the unlucky that’s been given the curse of chronic, unremitting pain, I may not see anything at all because you’ve learned to so bravely continue about your daily life and not allow it to hold you back.10/10 pain means the worst possible pain you could ever imagine. Is there not anything that could possibly happen to make you hurt worse? I’m not the one in your shoes, and I can’t claim to feel what you feel, but I have a hard time believing that the discomfort you are feeling from your nitro headache is anywhere close to how you would rate losing an appendage. A pain scale is subjective, I understand that, and what you are able to tolerate could be vastly different than that of the person next door or even me personally. But still, give some consideration to how it would feel to have an arm or leg ripped off or unsedated surgery and then tell me where your pain level falls.

4. Sometimes making you happy and making you better are not one in the same. When it’s possible, I promise I will do everything in my power to give you the best of both worlds. But when you’re scheduled for an endoscopy in a few hours, I’m not going to feed you. When your blood pressure is reading dangerously low, I may not be able to, in good conscious, give you the maximum dose of your pain medication. If you are admitted for heart palpitations, I can’t give you your daily cup of caffeinated coffee. This isn’t me being mean, lazy, or restrictive; it’s me being responsible and caring more about your health than your happiness when the two worlds are mutually exclusive.

5. I wish you could see what I truly do. I do this job because I love it, and couldn’t imagine myself doing anything else. But when you make comments like “You’re not doing anything” or “My nurse was barely in here this shift” they can be incredibly hurtful, because you don’t see the half of what I do. For every ten minutes I’m in your room, it’s likely that I’m spending an hour managing your care from the command station that is the nurse’s desk. I’m on the phone with doctors, conversing about your latest test results, updating them on your condition, even suggesting interventions that I feel will make you more comfortable. I’m walking down to the lab to hand-deliver your blood and specimens. I’m double checking with pharmacy to ensure the doses and frequencies of your medications are correct for and do not put you at risk with their interactions. When I’m not doing that, I’m on my computer, documenting every little abnormality I saw on my assessment so that changes in your condition can be quickly met. I’m reading through your orders the notes that the doctor made and making sure that I’m up to date on your treatment plan and that nothing is getting lost in the shuffle.

So please, coming from a nurse who cares about her patients and care about her profession as I feel like the majority of us do, don’t say that I don’t try.

A (night) in the life of a night shift nurse

A few months ago, Nurse Eye Roll posted a post entitled A Day in the Life of a Nurse (all credit for this idea goes to her). Without further ado, here is the flip side of that, what happens in the wee hours of the night when day shift is off the clock, our patients are all “asleep”, and it’s always 7am somewhere.

Dedicated to all of you hard working night shift nurses who are reading this on your smart phones right now while trying to pass the time.

Wake up, wide awake, look at the clock, and realize it’s only 2pm

Trying to go back to sleep… trying to go back to sleep…. trying to go back to sleep

When I hear my neighbors kids getting off the bus, and the dog barking, and LAWNMOWERS.

New plan for surviving tonight: COFFEE POP REDBULL

About the time my alarm was set to go off

Walk out my front door

Get to work and discover I have three admissions, a discharge, and a transfer waiting for me, and we’re short-staffed

Long-winded coworker takes half an hour to give report on three patients

Okay day shift. You can go home now. 

Going around, quickly meeting my patients, and asking if they need anything, which turns into thirty minutes of listening to a patient’s entire life story

Discovering the previous nurse waited until right before shift change to give the Kayexelate and Milk of Mag cocktail ordered at 4pm 

When my most time-consuming patient is watching that TV show that I was really upset about having to miss tonight

Patient’s family comes to find me because my patient is coughing

and because they think they have a fever

and because they think they have Ebola

One patient wants pain medication, another needs to be changed, a third one has a SBP in the 70’s, a family member is on the phone and I have to pee

Oh, and you’re getting another admission

Passing meds, handing out apple juices, driving my computer around like a boss and saving the world 

Finally finish my med pass and assessments. Now it’s time to sit down and do some uninterrupted charting

When I am FINALLY sitting down and my IV starts beeping

Finish charting an entire assessment, only to realize I forgot tonight is scheduled system maintenance and the computer system went offline before I had a chance to save it.

Seriously.

When my H&H comes back and I have a standing order to give blood if their hemoglobin is below 8… it’s 7.9

It’s not even midnight yet?!?!

Time for lunch break, dinner break, or whatever-I’m-supposed-to-call-my-middle-of-the-night-meal break

Realize I left my lunchbox on the kitchen counter, it’s too late to call someone to bring me food, and the cafeteria just closed. So now, dinner is graham crackers and applesauce

Ask my coworker to help me change my patient and they let one rip as we roll them

Nope. Not just a fart after all

When I tell my patient I’ll bring them a sleeping pill… then I realize there’s not one ordered

Then I realize there’s not a hospitalist on their case

So, have to call the surgeon for an order and get yelled at for waking him up

I can’t give my patient an Ambien? Okay, that’s cool. What about a Restoril? No? I can’t even have a Benedryl? Really?

Patient is finally asleep and I realize I left something in their room

The time of the night when my “pleasantly confused” little old lady turns into the devil incarnate

It must be 3am now

Coworker misses their IV stick and calls me to try

Accidentally wake up a grumpy patient while hanging their 4am Zosyn

Home stretch… I’m awake… I’m awake… I’m awake

5:30am. Time to wake everyone up for their Synthroid and Protonix, at which point they will also need to pee and want their Lortab

Check a blood sugar and my patient doesn’t need coverage!

Half an hour before report and my IVs all go bad and my patients all have to pee. again.

Finally caught up and waiting for day shift to come

Day shift shows up late and spends fifteen minutes chatting and fixing their coffee

Oncoming nurse asks me 92830498234 irrelevant questions that I have no idea what the answer is and I also don’t care

FINALLY GETTING OUT OF HERE

I’M GONE

DONE.

(At least, until I have to go back in twelve hours) 

To Nina, to Amber, and to nurses everywhere

I’m not one of those nurses who has spent thirty plus years riding the ebb and flow of this constantly changing profession. I don’t have the wit and written eloquence of Kati, known to most of you as Nurse Eye Roll. I don’t have the feisty presence of Katie Duke, my infamous nurse comrade featured on ABC’s best-show-ever NY MED. I don’t have the insight and wisdom of so many of the elite nurse bloggers. For the past two and a half years, I’ve been your run of the mill ICU nurse. I stick to expressing my thoughts in 140 characters or less (find my primary home on twitter at @RNMeetsWorld), I keep calm, and I carry on my way.

But today, as news spreads about not just one, but now TWO of our fellow nurses being diagnosed with this enigmatic virus, I want my voice to be heard just as loudly as those criticizing, finger-pointing, and blaming. Fears over Ebola are sweeping across the world in exponential form. My family is panicking, my friends are panicking, and even my medically-trained coworkers are panicking. I went to the optometrist this morning, healthy as a horse, and the first question they asked me was about recent travel history. Flipping through the channels this afternoon, I saw an advertisement for N-95 masks in the context of Ebola, and I couldn’t help but groan. I ask my patients, or at least the conscious ones, if they have been out of the country simply because I want to be certain that nothing gets missed, and even worse, that I’m the one who missed it. I am being vigilant.

With that said, I am getting tired. I am tired of being asked how I feel about these two young ladies who share my passion contracting the disease while on the clock. I plead the fifth when it comes to just how many acquaintances I have unfollowed or unfriended on social media due to posts that I find offensive, derogatory, or flat-out ignorant when it comes to my profession. I have now perfected a monologue to offer when someone raises an eyebrow and takes a figurative step back as I introduce myself in public as a nurse. I’m sick of pretending to laugh off jokes about “You haven’t caught Ebola, have you?” I’m tired being asked if I am scared, or even if I regret my decision to become a nurse.

Not for one second.

I’ve been watching the news today, and I’ve come to an alarming realization. I could be Nina Pham. I could be Amber Vinson. I could be any one of the many other nurses who willingly put their lives on the line ensure Thomas Duncan received the best care possible. I work in a suburban ICU, an Ebola patient would never show up here. It won’t happen to me. Right?

Wrong. Texas Presbyterian wasn’t expecting to become ground zero either. Had Mr. Duncan shown up at my hospital instead, I very well could have been the one taking care of him. He wasn’t transferred to a specialized isolation facility like Emory or Nebraska, although CDC officials are now admitting that, in hindsight, he should have been. He was cared for in a generic intensive care unit in a hospital just like mine, by nurses who have been trained just like me.

Would I volunteer to take care of an Ebola patient should one darken the door of my own Emergency Department? I like to think I would accept the call with no hesitation. I’d like to think I would be courageous in the face of the unknown. That I would have enough confidence in my gowning and gloving and masking to feel armed enough to handle a disease of this virulence. That I would stay true to the commitment I made, before my perception of nursing was muddied by incessant charting and The Joint Comission and the politics of healthcare, that mantra of I will care for people when they can’t care for themselves.

To Nina Pham and to Amber Vinson, I am sorry. I am sorry that you have to be the butt of criticism over whether it’s you who is at fault, or your hospital, or Obama, or the CDC, or whoever happens to be the scapegoat of the day. I hope you’re getting to Skype with your families, and your friends, and your dogs. I hope that you are fighting hard, and feeling better. If you have a foley, I hope you were groggy enough when your coworkers put it in that you’ll never remember it. I hope you’re shielded from the criticism being directed at you, and that you are not watching the news right now to hear your character and your unspeakable bravery slandered by the uneducated public and the media frenzy. You took a risk that few would be willing to take, and I commend you for it. Thank you. 

Amber, I hope you are settling in well at Emory Hospital. Atlanta is a great city, I promise. I spent quite a bit of my childhood there. I wish you were getting to visit the Coke museum and catch a Braves game and sightsee at Centennial Park instead of staring at the bleak walls of an isolation unit in a strange city, far away from your loved ones. Nina, I hope being able to see the faces of your coworkers brightens your situation just a little bit, and that you know they are hurting with you.

You are both heroes, and I only hope that I would be as brave as you if I was walking in your bright yellow, rubber-soled hospital socks right now.

My life is defined by a belief in God, in prayer, and in the words of Romans 8:28 and Jeremiah 29:11 – That God has a plan, and that in all things he works for ultimate good. I don’t say this to get into an argument of why a good God would allow such a tragic thing to overtake Africa and now infiltrate the borders of Europe and America. I am wrestling with those questions myself. But I say this because, regardless of what anyone may or may not believe, I try to look for evidences of good speckled in with immense tragedy. I see the bravery and good spirits of Nina and Amber shining through all of the negativity. I see the selflessness of staff at Texas Presbyterian Hospital who continue to treat one of their own in the midst of fears that they will be the next to have their face plastered on CNN while they fight for their life in isolation. I see Dr. Kent Brantly, who has recovered from Ebola and is now offering anything he can to help others fight, being proactive in donating his own plasma again and again. I see the thankless work of a countless number of volunteers who have willingly chosen to put their lives on the line to treat the least of these in West Africa in conditions far less advanced than those here. The good is hard to find, and it’s dim, but it’s waiting on the horizon. It may get darker before the dawn, but keep fighting for it. 

And so, to my brothers and sisters in white, or ceil blue, or jade green, or whatever rainbow your hospital’s policy dictates: Live in caution, not in fear, and always remember why you do what you do and the heart behind it.

And please, please, please. Wash your hands.