At the very beginning of our shift, we received a transfer from the telemetry floor; a 50-something-year-old woman who was admitted 2 days prior with chest pain and elevated cardiac enzymes.
And, at the time, that was all the information we had. She arrived to us having 10/10 (worst pain imaginable, per patient report) chest pain, she was vomiting, diaphoretic (sweating), and so short of breath that she could barely sit back in the bed long enough for us to get a 12-lead EKG. Her EKG showed major ST changes and her blood pressure was quickly dropping to 62/34.
By this time, multiple calls had gone out to the cardiologist and he had scheduled her to go to the cath lab at 10 a.m. (it was 9 a.m. at this time) and he was given all the same assessment information that we had in front of us.
Nurses are expert professionals that provide direct patient care. There is no other business or healthcare professional that is taught or tasked with the critical thinking, the science, the legal responsibilities, or the multitasking workload of the clinically performing nurse. Clinically practicing nurse professionals have no less than (and some have more) education and experience than their nurse-colleagues that have chosen not to perform in a clinical environment and instead pursue careers in nursing leadership and nursing education.
Nurses are college-educated, board-tested, and licensed to practice nursing; physicians are also college-educated, board-tested but they are licensed to practice medicine. Nursing professionals are not responsible for medically diagnosing patients or performing surgical procedures, hence the additional four years of graduate medical education is not needed. Both professions enter into residency periods following graduation that provide supervised training for the independent and specialized practice of their careers. Nurses are not doctors, obviously, yet neither are they junior-doctors, wanna-be-doctors, doctor-servants or in any way connected to the practice of medicine …other than they share a patient population and a goal – the safe healing of patients.
I have watched with reserved opinion and bridled interest as the first of you graduated your Masters of Nursing programs and entered our ranks at the bedside of patients throughout the hospital. We’ve all been watching you.
When you were in “clinicals”, we were fascinated that you knew almost nothing about patient care. Some of you knew less than nothing. You had no clinical group class, per se, with an instructor to assist you. Each of you were individually assigned throughout the hospital and regular clinical staff were assigned to babysit teach precept you. Most all that you learned clinically, was taught to you, one-on-one by good ol’ regularly educated, trained and experienced nurses. Nurses that were confused yet happy to share with you.
I often get frustrated at work with the difference in the way doctors think to the way that nurses think. (Well, the good nurses anyways). Doctors don’t often see the “big picture” or what’s in the patient’s best interest. An example from my work week: Patient has been in the hospital for 3 weeks. He had open heart surgery, followed by a long recovery plagued by respiratory, musculoskeletal, and mental/cognitive issues.
For 3 days or so, we (the medical team…nurses, all 6 doctors on his case, social services) had been talking about sending this man to a rehab facility to improve his strength and coordination until he is able to return home… very common occurrence for our long-term patients. By the time we started talking about the patient being transferred to this rehab facility, he was fully ready to leave the hospital.
He’s sick of his ICU bed, sick of the same ol’ hospital food, sick of the daily routine, etc, etc; long story short, he needs a change of scenery. So, we have everything set into place, all the doctors have signed off on the case so the patient can transfer except the hospitalist.
All throughout my childhood, I dreamed of becoming a doctor. I remember playing with my plastic stethoscope and mapping out the dream estate that my millions of dollars would buy for me and my family.
Through high school, I ended up working as a pharmacy technician for a retail pharmacy, which made me decide that pharmacy school was the path I should follow; realizing all the legality and time-limitations (in patient care) that doctors faced turned me off to medicine.
So, I applied to my dream college, which was a liberal arts schools as pre-pharmacy, but very shortly after starting my first semester of chemistry, I decided that I couldn’t do another 11 semesters of those classes (sick).
So, I talked to my college friends, most of whom were nursing majors, and decided that I could see myself as a nurse. I switched my major, did a semester of summer school to get caught up with pre-requisites, and then my nursing major was officially underway.
…your job is easy to but I don’t want to be a garbage man. Nurses are a mix of maid and babysitter anyone with an 8th grade diploma could do it its not hard to do. I guess good nurses are around because who else would get coffee for the doctors.
This is an inflammatory comment left by a fool in the midst of a jumble of comments following this article from Michigan. The comment is asinine and I usually would pay it no attention, but I am hearing and reading this genre of spittle more and more often.
This mindset definitely makes me wonder if this is a sad backlash of our economy, our union activities and the employment situations in which nurses are finding themselves – more “labor” (believed by the masses to be unskilled, at that) than “professionals.”
Are we not worthy of respect and a seat at the Big Boy Table? Do they understand how much work we have and that our education is demanding?!
Here are some of my observations:
Neither medical nor legal professionals are standing on State Legislative lawns with signs.
I was taking care of a younger (read: in his 50’s) patient last week. He developed flash pulmonary edema following severe mitral valve regurgitation requiring him to be intubated, treated, extubated, transferred to our hospital for mitral valve repair. He was intubated for surgery and then post-operatively we had a hard time getting him off of the ventilator (he was on 100% FiO2 and 10 of PEEP just to keep his SpO2 in the mid-80s).
I was his nurse on the day of surgery as well as post-op day #1, so the first day he was still under anesthesia, but when I walked into this room on my 2nd day with him, he was wide awake and able to communicate with me more than I had been able to communicate with any other patient prior to him in my career.
If you have ever taken a job in a hospital facility as a clinical staff nurse, then you most likely endured a clinical orientation. Did you love it?!! The really great orientations are imprinted on our psyches and embedded in our hearts. …The really bad ones are enough to make anyone quit the practice of nursing. Even non-nurses. I became a mentor to 2 wanna-be neonatal nurses, this post is dedicated to them.
Since those really are the only two choices – a Good O or a Bad O –
the Muse, RN is happy to start the following list in service to:
our future co-workers
…whose hearts deserve our warmest welcomes & best instruction
our Preceptors & Nurse Leaders
…who have always had the ability to make it so.
I have really enjoyed blogging over the last few months, most recently with my old WP.com account that some of you have been following. As I realized how much I was enjoying it, I also realized that I wanted to get a little more “official” with a domain.
So, I enlisted the help of the one and only Chuck Reynolds (an amazing web developer who also happens to be my boyfriend) to merge my old WP.com blog onto my new domain. He has shown me a great deal about reputation management and personal branding, both of which I have embraced.
I am an extremely passionate person – I throw myself wholeheartedly into anything and everything I do, and my work is no exception. I love my career, through all of the ups and downs that I experience each and every day and this blog has been an outlet for talking about those out-of-the-ordinary days.
For those of you who may not know me, check out the “About” tab at the top of this page and you’ll get the dirt. If you’d like, you can subscribe to this blog’s RSS Feed to keep up to date.
The patient’s letter was short and angry. I had not helped her; she did not plan to return to see me. And, she didn’t; she might as well have moved to Australia, such was her silence.
Six months earlier, she had undergone a temporal lobectomy for epilepsy, present since her teens, usually manifested by episodes of being disconnected from her surroundings, and only partially controlled by medication. I had been her epileptologist for a dozen years, guided her through two successful pregnancies and assuaged her nervousness about her condition several times a year. Her brain scans showed a stable cystic lesion. We had often discussed surgery, but she was not ready until she had a major motor seizure at age 35, almost 20 years since one other similar event had heralded the onset of her condition.