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Interview – Director of Nursing

“NurseExec” is the Director of Nursing (DON) at a 120 bed skilled nursing facility that has a 50/50 mix of patients needing short-term rehab and long-term care.

After working in the OR as a circulator, she started out as a charge nurse in her current building, which entailed pushing a med cart and taking care of 20 patients.  After 9 months, she was promoted to Risk Manager and 3 years later became the Director of Nursing.

She starts her day at 7am by rounding on nursing units, consulting with unit managers on clinical issues, and dealing with grievances and employee issues.  She checks in with the charge nurses and CNA’s, checks shower rooms and utility rooms.  Then it’s off to Morning Standup with department heads, followed by clinical rounds with the interdisciplinary team to discuss new admissions, new orders, and a report for the last 24 hours.  Most days this is all followed with other meetings, lasting until 11 or so.

The afternoon is filled with reports, employee issues, clinical and education issues, pharmacy issues, and another rounding of patients.  She typically ends her day at 4pm.
What do you like about your job?

Every day is a different set of challenges, I have great benefits, and wonderful team to work with.

What frustrates you about your job?

People who know the right thing to do, yet don’t do it.  Makes me crazy!

What about your job makes you proud to be a nurse?

Meeting with residents, and hearing them say “So and So is a great nurse, I love being here”–that makes me not only proud to be a nurse, but proud of the staff member.

Do you feel you receive adequate support for your responsibilities?

I have a wonderful administrator who has been here as long as I have.  She and I are a great team, and we think alike.

What is something a nurse who does not work in your particular field might find surprising about your job?

Skilled Nursing Facilities are more regulated than any other industry (including hospitals) except nuclear power.  We have approximately 530 rules that we must adhere to on any given day, and that doesn’t include the state ones.  My first State Survey was an eye opener, that’s for sure.

Are you salaried or paid by the hour?

Salaried, with a clinical performance bonus.  Some days I come in early to catch the night shift, and some days I come in later to spend time with the 3-11 shift.

As the DON, does the buck stop with you?  Do you get called often on your off-hours to deal with situations?

Yes, the buck does stop with me.  It’s my license hanging on the wall, literally.  I have very competent unit managers and shift supervisors, but there are some things they need to call about.  I usually get a call every other day or so, including weekends.

Do you find that you can accomplish everything you need to do within the hours set for your position?

Some days are better than others.

Does what you do involve a lot of teamwork, or is it more of an individual job?

It’s more individual, with a lot of delegating and having the team follow up and get back to me on certain issues.

Was there any extra training besides on-the-job learning that you were required to complete for this job?

It was strictly on the job for me.

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom.  Do you find that to be the case with your job as well?

Meetings on top of meetings get me.  I finally just excuse myself.

(I’m sensing a trend here.)

Thank you to NurseExec for her great answers.  If you are or know of a nurse who doesn’t have a traditional bedside job, email me at codeblogrn@gmail.com.  My post about this project and a list of interviews done so far is linked here.

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Interview – Informatics Nurse

Ever wonder how all those hospital systems are created and maintained? (computer charting, systems to report data to national and state organizations, to name a couple)  Sure, they could hire some IT guy to run them, but everything seems to flow better with a nurse’s touch.  After all, we’re the ones using them all the time, right?  Jen C, RN, BSN almost MSN gives us a look into the world of nursing informatics.

Jen has been doing this job for 2 years.  She says she “stumbled into it” when she was interviewing for a new job and mentioned that she was starting her Master’s in Informatics.  Although she was hired to be a staff nurse, within 4 months she was working in Informatics.

What do you do all day?

Each day is different. I do a lot of troubleshooting. I go to a lot of meetings. I do system development and upkeep.  I listen to the nurses and what their issues are with the various systems. I do education. And I still fill in at the bedside (I’m still a NICU nurse at heart).

What frustrates you about your job?

Little definition and recognition as to what my job is. I often seem to be a catch all. I also don’t have a mentor. I’m the only one in my hospital that has formal education in this area and only 1 or 2 in the whole hospital.

What about your job makes you proud to be a nurse?

I still affect patient care. If I do my job well, the nurses at the bedside can do a better job of taking care of patients.

Do you feel you receive adequate support for your responsibilities?

No. I have no backup. I’m essentially on call 24/7.  And don’t get paid for that.  I can’t accomplish all I need to do within the constraints of my hours – I work at home too.  I am paid hourly for now while I’m in school.  I work 4 days a week 9-10 hours a day.

What do you get called about on your off-hours?

Case in point was this weekend. On Thursday night I got a call from the L&D charge nurse.  She told me that the patients weren’t appearing in the charting system they use. No one was moving out of the beds either, despite admissions doing it in their system. The charge nurse had already called the house supervisor who called IT and got nowhere…. So they called me. I was able to troubleshoot over the phone and call the right person in IT directly. Yesterday another charge nurse called me that there were two charts for a patient, and asked if I could fix that.

What is something a nurse who does not work in your particular field might find surprising about your job?

I know more about evidence based practice than most bedside nurses. You can’t expect staff to chart based on evidence based practice if the charts don’t support it. Recently I had to change the way our lactation nurses charted to support the evidence. I’ve done similar things for our neonatologists and gynecology nurses. Often I find out about the changes and pass it on to staff (who usually have no idea).  I also know far more than I ever wanted to know about rules and regulations and core measures. I have to keep my clinical skills sharp. If I don’t do the above, I can’t build an effective system.

Does what you do involve a lot of teamwork, or is it more of an individual job?

It’s both. The actual building of a system is a one man job, BUT getting to that point requires teamwork. I also need the staff to work with me in order to meet their needs.

Was there any extra training besides on-the-job learning that you were required to complete for this job?

You need to be trained on the system(s) you work on. It does help to have formal education in informatics. I see a big difference between myself and those who have no formal education. You get the “big picture” with the formal education.

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom.  Do you find that to be the case with your job as well?

It depends. When the poop hits the fan, then no, but most days yes. Eating is another story.

What is nursing informatics’ definition of “poop hitting the fan?”

This is a very geeky answer, so bear with me. One system I support runs on a primary and backup server.  This past summer one server started to fail. In layman’s terms, the server is supposed to run on 4 wheels, we lost one, but it was ok to run on 3 wheels. In the middle of a very busy Sunday afternoon, the 3rd wheel blew, killing that server.

It was a hairy couple of hours while we configured everything to run on the one server. (Since it was Sunday I flew into the hospital to start dealing with it). Another time, one system wouldn’t talk to any other system and just froze up.  It was our fetal monitoring system, so it was a crisis.  I got very well acquainted with tech support that day.  We were down for roughly an hour (so no central monitoring for fetal monitoring).

Thanks to Jen for her explanations of what a nurse in informatics does.  Good thing we have someone on the IT inside :)

(My post about this project and a list of interviews done so far is linked here.)

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Interview – Developmental Disability Nurse

For my first interview, I thought I’d interview someone who would tolerate my novice interviewing abilities – my mother :)  Ginny, RN, BS, DDRN has been a nurse for over 30 years, most of that time in the Intensive Care Unit.  (The apple did not fall far, did it?)

She currently works as Developmental Disabilities Nurse and has done so for 9 years.  A developmental disability is defined by Wikipedia as a term used in the United States and Canada to describe life-long disability attributable to mental and/or physical impairments, manifested prior to age 18.”  Ginny says that her clients have a range of mental and physical disabilities including cerebral palsy, Down’s Syndrome, mental retardation, and autism, with autism being the most prevalent.

Her clients live in normal houses along with nurse’s aides and “direct support professionals” (DSP’s).

How did you get started as a Developmental Disability Nurse?

A friend encouraged me to come work with her after I lost my job when they closed the children’s home where I had been working.

Do you like it?

I have had other nursing jobs including med-surg, peds, ICU, factory nurse, WIC nurse, children’s home nurse, and finally this job.  I have liked all of my jobs but this has been the most rewarding.  The people I care for just love it when the nurse comes around.  There is always a “thank you” in their eyes.

What frustrates you about your job?

It is of course a job which requires state controls.  Their idea of “nursing” is an awful lot of useless paperwork that makes no sense to me.  The pay is not commensurate with other nursing jobs considering the reponsibilites of delegating nursing tasks to laypersons.  There are so many things these people need and it’s hard to get.  There are so many state mandates that are designed to move people toward being as independent as possible but the mandates also make us take many steps backward in that process.

What about your job makes you proud to be a nurse?

When I can allay someone’s fears about their problems.  Doing this with persons who cannot speak and many times cannot move around can be a challenge.

Do you feel you receive adequate support for your responsibilities?

Support in the form of “words.”  I don’t know what would happen if something serious were to occur.  Last year we had a run-in with the health department and even though the personnel manager was there at the time they did not think about supporting us – they were more interested in schmoozing over the people at the health dept because we don’t want to “upset” the community people.

What is something a nurse who does not work in your particular field might find surprising about your job?

That we actually teach medication administration to CNA’s and DSP’s who are not licensed to give medications.  That persons with disabilities are very fun, caring, and lovable persons.

What do you do all day?

When I arrive, I pick up messages from staff  on my email and telephone.  After getting those squared away, I go and see the consumers who are sick, injured or have some thing for me to “look at.”
I go to service plan meetings for individual clients where we discuss their programming and medical needs for the next 6 months; their guardians, case managers, and nurses all come together as a team.

I process all new medication orders from doctors and make sure the staff understands everything about the medication, including how to administer it.  We have to give meds during day programming; staff aren’t allowed while we are available.  We are the go-between for all the different docs clients have.  Some have 4 and 5 specialists including ortho, psych, EENT, family doc, neuro, podiatrist, urologist just to name a few.  We check in all medications at the end of each month (about 500 bubbles), and follow up on med errors and missing meds.  We teach med administration and health every month to new employees and do annual med review classes.  Of course we have several committees that we must participate in: safety committee, QA, behavior management and human rights.

Are you salaried or paid by the hour?  What are your hours?

I am salaried. I work days and have flexible hours as needed for me personally as well as what the agency needs – such as going to watch staff do meds at 6 in the morning or at 8 pm at night.  I like the flex hours.  Just not the “extra” hours.

Do you find that you can accomplish everything you need to do within the hours set for your position?

NO!!  Some days are fine but most days are not.

Does what you do involve a lot of teamwork, or is it more of an individual job?

Quite alot of teamwork which includes another nurse and case managers, access persons from the state and of course all of the caregivers that work in day program in the home, and the physicians they see.

Was there any extra training besides on-the-job learning that you were required to complete for this job?  (ie, a degree or certificate other than what was required for you to become an RN?)

No required “training” except a 1 day course “Nurse Trainer” for the state, plus have to have worked in nursing for at least 2 years.  Certifications can be obtained but are not required.  I have my certification in Developmental Disability Nursing through a national organization.  It was difficult and my agency did not help pay for any other training, or for taking tests, etc which was kind of expensive.

One of the biggest complaints given by hospital-based nurses is that they rarely have time to eat or go to the bathroom?  Do you find that to be the case with your job as well?

On some days this happens!  One day this week I did not get a chance to go to lunch and didn’t realize it until my head started pounding.   As an ICU nurse (30 years), we had  a bathroom very close by.  I never peed my pants but almost!

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So there you have it, my first interview with a nurse who does not work a traditional bedside job.  Thanks mom! :)

If you are or know of a nurse that works in a nontraditional setting and are interested in being interviewed, email me at codeblogrn@gmail.com.  My post about this project and a list of interviews done so far is linked here.

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Nurse Turned Patient

Hey everyone.

A friend of mine started a blog and I wanted to send some traffic her way.  Go check out Nurse Turned Patient.  As the title suggests, it’s a first-hand account of medical procedure that she underwent told from the perspective of a nurse.

I’ve had several nurses write to me about the interviews!  A few have completed them and I will be posting about one per week.

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Wanted: Nurses to Interview

I seem to have developed an interest in other fields of nursing.  I think the most “typical” nursing field is probably med/surg in a hospital.  But nurses are everywhere!  What about nurses who work on cruise ships?   At stadiums or on movie sets?  Are there nurses who work for NASA?  On Antarctica?  This blog has mainly been about my experiences in CCU, but I’d love to learn more about what other kinds of nursing jobs there are!

I decided to start a new category for codeblog that will hopefully become a recurring feature.  I’d love to interview nurses who work in offbeat areas.  I’m interested in what your day is like, what you do, what your experiences have been.

If you work in an unusual field of nursing, one that isn’t “mainstream,” write to me at codeblogrn@gmail.com.  Even if you do work in a mainstream field (hospital, school, prison, etc) and you are interested in being interviewed for this blog, feel free to write to that same address.  Doesn’t matter if you have a blog or not.

Interviews posted so far:

Nurse who works with the Developmentally Disabled

Nursing Informatics RN

Director of Nursing, Rehab/Long Term Care

Correctional Nursing

Nurse Journalist

Cardiac Cath Lab

Nurse Author – Tilda Shalof, RN

School Nurse

Operating Room – Assistant Clinical Nurse Manager

Humanitarian Nursing

 

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Making The Call

A patient codes.  Almost simultaneously, a multitude of actions are set in motion.  When the nurses and therapists at the bedside know each other well, it’s almost like a dance, everyone moving fairly gracefully around each other and the equipment flooding into the room.

Someone watches the monitor, someone makes sure there’s a line and starts one if necessary.  Others give meds, record events, defibrillate, bag the patient, do CPR.  Someone is sent out to call the doctor.

Once the dance is well established, once we are in the middle of doing everything, someone always throws out the suggestion, almost as though it were an afterthought – “someone needs to go call the family.”

During one code, I was the runner.  I didn’t have a specific job; I was just running to get supplies as needed.  After I’d run to get suction tubing, more paper to record on, this, that and the other thing, I was just watching and waiting to see if anyone needed anything else.  Although what was happening was very sad, I was admiring the dance.  Everyone there that day knew each other very well and it was especially graceful.  Which is why when the suggestion was uttered, I was the one available to do it.

Would you believe it?  After over a decade of being an ICU nurse, I had never before been the one to make The Call to the family.  Do I call and be vague?  “Hi, this is the hospital and your mom has taken a turn for the worse.  You need to come in right now.”

“Oh no!  What’s happening?  What’s going on there?  Is she okay?”

“Just come in.”

I don’t really like that approach.  The unknown, in my opinion, is often more stressful than the known, even if it’s bad news.  I think the prevailing explanation was that giving someone such awful news would result in them driving to the hospital at break-neck speed, possibly creating a higher chance of getting into an accident due to being so distracted.

I think that chance exists whether the family knows the details or not.

So I told them that their mom had taken a turn for the worse, that she stopped breathing, the nurses and doctors were trying to help her, and they needed to come in right now.

The patient was sick, but as far as I know wasn’t expected to die anytime soon.  Still, the family member I spoke with took it better than I had expected.  I’m not sure what I was expecting – for them to exclaim “Oh my God,” drop the phone and leave immediately?  Hysterical questioning?

In fact, the person I spoke with was so calm that I wasn’t sure I was conveying the gravity of the situation.

“I don’t know if she’s going to survive this.  Please come as soon as you can.”

“Okay, we’re coming.”

And thus ended the call.

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Nurses Find The Weirdest Stuff…

I know that she swears she isn’t making it up, but still I sort of wonder if it’s true.  However, since the only real criteria for a story submission is that it be interesting, this definitely qualifies.  Lauren writes:

This post can go under the heading of stories which prove that truth is indeed stranger than fiction. I returned to work last night for the first time since before Sofia was born (boo hoo). That was upsetting and new for us both but it is not, alas, the subject of this posting.

I was scrolling through my work emails furiously trying to whittle down 400 plus messages that had accumulated during the time I was basking in the glory if a 16 week maternity leave (by the way, thanks Mom for the flowers. They softened the blow a little tiny bit). I found reference to a strange story within the hords of mundane postings and notifications and decided to delve a little deeper by asking my coworkers about it. Luckily for me, the girl who had originally posted the tale was working in my area with me and she was most happy to fill me in, to my initial horror and eventual hilarity.

Apparently, there was a patient admitted to the ER with crushing chest pain or some such malady. She was bundled off to radiology for a CT scan and then sent to the cath lab for a cardiac catheterization. She eventually ended up, after taking a tour through these several areas of the hospital, in the ICU and the very capable hands of Teresa the ICU nurse. Teresa decided, being the excellent nurse that she is, that the patient would enjoy a linen change after her adventures of the day. She therefore turned the patient over in bed only to find a dead cat beneath the patient. Yes, dear reader, I did not mistype. She found a dead cat. Underneath the patient. After the patient had been through the ER, moved to the CT table in radiology (love to see that film someday) and to the cath lab where they insert large-bore sheaths (they are so friggin large that they aren’t even considered needles at that point) into her groin area and finally ended up in the ICU before anyone noticed that there was a deceased domestic animal beneath her. I swear that I do not make this up.

Apparently, an incident report was filled out, the house supervisor was notified, and the animal was disposed of after a quick and appropriately somber moment of silence. And this, I realized, was a clear and obvious message from the cosmos. “Welcome back, Lauren” the cosmos said. “We could tell you were gonna need something like this to get you back into the nursing spirit.” And, suprisingly, it did. You won’t blame me if I feel the need to check beneath my patients for dead animals from now on though.

So… was the cat left on the gurney during her CT scan?  Surely someone would have noticed it on her films, right?  Did the lady know who the cat belonged to or where it came from?  I’m just so perplexed.  More info from Lauren in the comments:  “Further info…the patient was in no condition to be questioned about the kitty, but when a call was placed to the patient’s family they confirmed that they did indeed have kittens running around and one of them was indeed missing.  I think the patient was quite large and was being slid, along with draw sheets and other assorted linens, back and forth to the Ct table and cath lab table.  Presumably, kitty just went along for the ride.  As for the CT film, I’m still wondering about that one.  And no, I’m not a sicko who thinks dead animals are hilarious.  If it had happened while I was there, I would have lost my lunch.  But hearing about it afterwards, with all the gruesome details was kind of…shockingly hilarious I guess.  In a very macabre way.”

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Nurse Vs Policeman, and Other Topics

So who hasn’t heard about The Policeman vs. Nurse?  A nurse was pulled over for speeding, told the policeman that she hoped he would never end up as her patient, and was subsequently fired when the policeman complained to the hospital she worked at.

Really?  I have the utmost respect for the police of course, but put on some big boy undies and get over it.   Should the nurse have made that comment?  No.  Not in front of him, at least.  That was pretty dumb.  But being fired for saying it is ridiculous in my opinion.  Does that cop go complain to the pimp when the hooker he’s arresting makes a sassy comment?

Hey, I just saw that Nurse and Lawyer had a pretty good discussion about the whole situation.

Next up:  Rapid Response Teams Sign of Poor Bed Management.  Really?  I think GruntDoc summed it up best in his tweet about it.  The article states that Rapid Response Teams (RRTs) are utilized due to overcrowding because sometimes patients aren’t placed in a unit that is appropriate for their needs.  Therefore, their condition worsens and they need help.

I suppose all hospitals are run differently, but at the one I work at patients admitted to the ICU are sometimes rock stable.  Seriously – orders like, “Saline at 100cc/hr, Regular diet, Up ad lib.”  No pressors, no oxygen requirements, no aggressive pain management.  Why does the doc then order an ICU admission?  I don’t know.   Maybe they just have a feeling, although that’s not really a good enough reason to admit to ICU.  Regardless, it’s unusual that a very sick patient is admitted to a regular nursing floor.  We actually tend to err on the side of caution.  If a unit that provides a higher level of care has no beds, the patient stays in the ER until a bed opens up or until they stabilize and can safely be assigned to a room on a regular floor.

RRTs are an excellent resource.  Basically, if a nurse on a regular floor is taking care of a patient that seems to be deteriorating, they call for the RRT to come help out.  A nurse and a respiratory therapist (maybe others) respond to the code and help the patient’s nurse out.  How could having MORE people assessing/treating you/notifying your doctor be a bad thing exactly?   I don’t believe RRTs are called because the patient was already in bad shape and assigned to a low level of care.  I think they are called because stable patients just stop being stable sometimes.

RRTs are a way of getting people to come help you before it becomes necessary to call a code blue.   Personally, if I worked on a regular floor, knowing that I could call someone experienced to come assess a patient who was doing poorly would make me feel very secure.  Like someone had my back.  And the patient’s back, actually… there would be someone there helping the patient while I went to go call the doc.

Anyway, I know the article isn’t saying that RRTs are a bad thing.  But I’m not sure the reasoning for their use is on target this time.

Last:  Harvey MD sent me an app that he thought would be of use to nurses.  It’s a “credential reminder” to help keep track of when our various certifications expire/time to do the TB test/keep track of our CV’s.  I can’t say I’ve used it, but it does look fairly useful if your employer isn’t the sort to start hounding you about these sorts of things coming due MONTHS before they actually expire. Ahem.

Actually, that wasn’t last.  I have a bit of a rant.  I took a photography class this weekend.  It was about how to use your digital camera, tips n tricks and all that.  Very interesting class, but something the instructor said kind of offended me, and I don’t think I’m the type to truly get offended easily.  She was talking about the “scene modes” and was telling us that the camera manufacturers decided to use the little icons in the menu (the party hat, the snowman for snow scenes, the lady for portrait pictures, etc) “in case you went to nursing school instead of taking photography classes” so we’d understand what each scene the icon represented.

I’m sorry, what?

I know what she meant, but good grief.  What a crappy thing to say about any profession.  Especially nursing!  I know how to use an unbelievable amount of equipment (IV pumps, balloon pumps, CVVH/dialysis machines, cardiac output machines, monitors, etc etc etc) none of which have any icons except for the little button that has a slash through a bell.   That one is very important :-)

If she’d had an occasion to ask me what I did, I would have replied, “I’m a nurse.  You know, one of those people that they dumb down the cameras for.”  Alas, no opportunity presented itself for that ultra-witty comeback, so it’ll have to remain unsaid.  Or blogged.  Whichever.

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Tough and Not Very Friendly

Jennifer, RN writes:

My name is Jennifer, and I am a staff nurse. Every day I enter the revolving doors at the hospital, and I am presented with a new set of challenges and experiences different from the last. Little did I know that one day in late November I would have the opportunity to care for a very special person who was facing the most challenging crisis of his life.

In report I listened to words like, “tough,” and “not very friendly,” and quite honestly I was a little apprehensive to enter the room of this angry man. “Bob” is a man in his mid 40s who has spent the greater part of the last five years in the hospital. Diagnosed with cancer and AIDS he has endured more testing and operations than most of us will experience in a lifetime. Bob was admitted with a high fever and cough to rule out tuberculosis and had been assigned to the isolation room on the unit.

I entered the anteroom, gowned and gloved. I peeked through the glass to see a frail man covered up to his chin in a mountain of blankets, shivering. I put on my respirator and entered the room. While I realize the importance of wearing the mask, there’s something about it I hate. It creates one more barrier between the patient and me. Facial expressions, especially smiles, are hidden away. There is something so impersonal about caring for a patient on precautions. Being “locked away,” as Bob called it, being approached by people protected by shields so they can’t catch whatever infectious disease is suspected. All of these thoughts came to mind as I knocked gently on the door and entered the room.

The room was cool and the whir of the ventilation system was enough to drive anyone crazy. Bob barely stirred as I touched his arm with my gloved hand and introduced myself. It was quite apparent I was looking at a gravely ill man. Emaciated and weak, Bob reluctantly cooperated and allowed me to complete my assessment.

When breakfast arrived I made sure that I brought him his tray right away. Often, patients on precautions get overlooked as their trays wait in the anteroom getting cold. Bob didn’t have much of an appetite, but he asked me for some extra jam for his toast. Although he didn’t say anything, he seemed surprised when I returned a minute later with three different kinds of jam. A few minutes later, he called me in again. He needed to be washed and have his linens changed. As I washed him, I could see the disgust in his eyes. This was not something he wanted or something he did for attention.

As the morning wore on, I sensed that I was gaining Bob’s trust and began to try to talk to him about his treatment. It was obvious from the beginning that Bob was beyond frustrated; he was losing all hope. He was fed up with hospitals, blood tests, doctors and nurses. He just wanted to go home. But he lay motionless in his bed, “a prisoner.”

After lunch, I entered the anteroom and looked in on Bob. He sat staring at his full lunch tray. I was wearing my usual attire that day, some silly scrub top with cartoon characters on it, my hair in a ponytail. I knocked on the anteroom door, surprising Bob, and gave him a silly wave and a smile. No mask, no gown, no gloves. Through the glass, I saw a hint of a smile. I motioned for him to eat… eat… eat! He responded by lifting his milk and taking a sip. I felt I had made a bit of progress.

I had been away for at least a half hour when I saw a commotion at the nurses’ station. Three Security guards were outside of Bob’s room! I immediately felt a surge of adrenaline and rushed to see what the problem was. Bob had called the local police from the phone in his room and threatened to commit suicide.

I was far from shocked, however, I was slightly disappointed that he hadn’t confided in me. We had spoken earlier of his discouragement, but never to that degree.

As I entered Bob’s room, the guards went on their way and I was once again alone with Bob. I sat close to him on the bed as I had earlier that morning. He sat on the edge of the bed, bent over, head down. He was so frail, so sick, so thin. I didn’t know where to begin so I just sat. I sat in silence with him for a couple of minutes with my gloved hand atop his cold, bruised, hand. Finally, I said “Bob, why didn’t you call me? I would have come right away.”

He just repeated over and over, “I didn’t know what to do. I just didn’t know what to do.”

When a person threatens to commit suicide, it is very serious, no matter how unrealistic the threat is. It didn’t matter that Bob didn’t even have the strength to lift a fork. His threat was real. I stayed with him for two hours, gowned and gloved from head to toe. As the beads of sweat began to form beneath my mask, I was finally able to begin to gain a better understanding of Bob. The bitterness and anger he had been displaying to the other nurses seemed almost justified.

Bob had come to grips with the fact that he was going to die. It was inevitable, and it was going to happen sooner than he had allowed himself to believe in past hospitalizations. He had already refused any treatment for AIDS, and he was now beginning to refuse treatment altogether. We talked about this and what it meant, not only to him but to his family. After all, it was his 81-year-old mother who was “suffering the most,” being forced to watch him wither away. He said he wanted to “go quick,” so that his mom wouldn’t have to watch him suffer. In fact, he was not afraid to die; he was more afraid of the pain he was causing others.

Shortly thereafter, Bob was seen by a physician who ordered that he be placed on one-to-one supervision, meaning someone would be with him at his bedside at all times for his own safety. I completely agreed. The physician pulled me aside and told me she felt it was necessary to put Bob in soft restraints so that he would be incapable of physically hurting himself. A sense of anxiety came over me. Was I going to have to go back in that room and tie an already hopeless man down? What would happen to the relationship we had formed? I could not and would not do it. I told the physician how I felt, and together we discussed alternatives. I told her about my experience with Bob and the behavior he had been exhibiting for the last ten hours. I told her I didn’t think restraints were the right therapeutic intervention for this patient. If the physician felt it was necessary to apply restraints, she was going to have to go into that room and put them on herself, because I could not bring myself to do it.

We entered the room, and I have to admit, I was starting to get emotional, even angry. Thankfully, Bob was able to make a verbal contract with us, assuring us that he would not attempt to harm himself. It was that easy. The restraints were put away and I settled down.

Bob stayed for the rest of my shift under the watchful eye of a sitter. Before I left for the night, I stopped in one last time to say good-bye. I wouldn’t be back for a few days, and I thought Bob would be moved to another unit by the time I returned. I asked the sitter to take a break so Bob and I could talk like we had earlier in the day. Bob asked if I would be back tomorrow, and I honestly felt a bit of sorrow when I said no. I could tell he was disappointed, but I knew I had made a difference that day. I put my arm around his shoulder and gave him a squeeze. He looked at me and said, “Thank-you, Jennifer.” As I left the room, I heard the thud of the heavy doors and turned and waved good-bye.

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Some News and Some Links

Let’s start with the links.

I am a big fan of Atul Gawande.  His latest article in the New Yorker, Letting Go, had me riveted.  If you are familiar with my blog, you know that I am a big proponent of knowing when to say when where advanced medical treatments are concerned.

There were many passages that resonated with me, but this one did so the most:

The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Yes.  That exactly.

Next, I wanted to share a YouTube video that I saw at Head Nurse.   It’s called Orthopedia vs. Anesthesia and it touches on the single-mindedness some specialists have.   I laugh out loud every time I watch it.  As Jo says, it’s well worth the 3 minutes and 22 seconds that it will take to watch it.  Go!

If you haven’t read the Letter from Afghanistan on GruntDoc’s blog, you need to go do that.  Also well worth the few minutes it will take you to read it.

Lastly, there’s a new girl in my life.  She was born on July 22nd in the wee hours of the morning.  I went through the labor and delivery completely med and epidural-free.  Since there are apparently no medals handed out at the end of such an accomplishment, all one really gets are bragging rights, which I am going to take full advantage of right here.  :)

GabeAndAna

I am the luckiest mama in the world :)

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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