So there I was.... a brand new "old" IP nurse on a very busy medical/surgical floor in a very busy community hospital. I had my lil shiny new stethoscope and running shoes.... yes nurses wear running shoes... and it is with good reason! You are either running to the nurses station to get the orders for labs, medications, wound dressing changes or the like, or.... running to the patient to give the above mentioned meds, draw blood (or obtain samples from other various orifices) change or apply dressings to wounds. And of course in the middle of all this, you must be ready to get a call from a doctor (could be any from the various teams) to change said orders, or send the patient home. Did I mention during all this you must AT ALL TIMES be completely aware of how your patient looks, feels and what his/her vital signs are telling ME how they really feel! Well you do.... and not just for 1 patient.... but for all the patients you are assigned! It was possible to have 5 patients that you did full care for, but usually you had your patients AND were responsible for the 2 patients that your LVN was caring for. So the LVN gives the oral medications to her patients (and if time allows, a couple of yours too), and you, the RN, were responsible for the IV meds, and labs for these patients too. In addition to this, you were also legally responsible for ALL of the nursing care, even if you didn't personally do it.
If you think this is not so bad.... try it sometime.
If you were lucky, you had 2 or maybe 3 patients that had ONE issue.... let's say gallstones, with only one team of MD's advising. That would be REALLY lucky... because at a county hospital, you are treating the sickest of the sick in the community. The patients would most likely have additional health issue, like uncontrolled diabetes, renal failure, hepatitis, TB or a host of other things. So your patient with pneumonia would already have a compromised immune system and treating something, like pneumonia, would be doubly hard. In addition to the increased physiological difficulty of the patient, he/she would then have additional medical teams to communicate with as well. Let's use the example of a patient with pneumonia who has ongoing renal issues. This patient would have a a "medical team A" (they handle mundane issues like pneumonia), and a "renal team" (the kidney doc team) so that person would have 2 separate teams working on them. As the RN, it would be your job (legally and morally) to coordinate the care between the teams.
Oh did I mention that the county hospital that I worked for is a "teaching" hospital?? So this means that the "team of docs" (on each team) were also doctors in residency...ie... they were learning during all this care. Usually the MD teams would visit the patients early in the morning.... formulate the patient "plan of care" (POC) for the day. The resident had to present his/her POC to the Attending MD. The attending MD already had predetermined ideas as to how the care for these patients was going to take place. The wonderful thing about teaching hospitals is that there is a large volume of patients. It gives the all the health care employees a chance to really become familiar with a variety of health issues. By seeing a lot of the very sick patients, you are better skilled at identifying a symptom or situation that is not running the "normal" pathway. This allows residents to become familiar with various situations and the ability to formulate the POC independently, then, once approved, to be carried out. Part of this learning process involves the attending stepping back and allowing the resident to "figure it out on his/her own".... which is really the only way "critical thinking" is developed. It's a very supportive environment for the residents. They get to see POC's formulated and carried out numerous times. The philosophy at the hospital is "See one, Do one, Teach one". Which is an AWESOME learning method!! Teaching what you you learn really cements the information. Of course, this is done in varying levels... and with each additional year education, the resident rec'd increased privileges and responsibilities. Blah Blah Blah.... all this to say there sometimes were "layers" to physician care.
If the POC isn't going smoothly, usually a call to the attending will remedy it and get the ball rolling.... but you also had to deal with the ruffled feathers of the resident who you just undermined. Of course, undermining anyone was never an intention, you are just trying to "coordinate" a care plan that had some "wrinkles".
Now this brings me back to the patient who has more than one team of MD's. Sometimes, the teams do not play well together. On occassion (enough that I bring this up) one team will modify, or cancel out the orders of another team. You being the "coordinator of all care" sometimes feels like the steel marble in a pin ball machine.... being batted form one area to another. It can be even more upsetting to the poor patient who wants to know why this RN keeps "changing her mind" about the care of the patient. Even if there aren't conflicting orders, there sometimes are delays as one team waits for another team to finish their POC before implementing their own POC. And with that, I return to the fact that RNs' wear running shoes!
I imagine that some of you may be wondering what that heck any of this has to do with the Blessings that I received personally. I need to relate to you how intense the environment on a busy med/surg ward can be. The fact that you are interacting with a variety of personalities, and levels of skill, make you learn to trust your instincts. You learn that even though someone may have "the title" to tell you what to do, they may not have the skill, or haven't had the time to really investigate your need, to really guide you. When you "just know" something is wrong..... it usually is. Listen to the voice.... He is telling you to listen.
If you ever want to say thanks to an RN for what she/he does, go to any County hospital and take a tray of fruit to the med/surg ward staff. These are the hardest working people in the hospital! I know I probably will get some slack for this from my Labor and Delivery friends, but at least we, on occassion, will get a grateful patient who returns with her baby to show us what our hard work helped produce. I've yet to see a patient return to tell us how much the care for their gallstones meant to him/her! Not that those patients aren't out there.... but .. well I think you know what I mean. :)
Like I sometimes do, you may skip parts of a book that get a bit boring to get right to the "good stuff"... like... say the big Blessings I rec'd or the miracles I witnessed. This is one of those posts that's a building block to a future post with a purpose. Without this info, the rest might be as clear as mud!! So I ask for your patience. I have to say that for the first year of my nursing practice, I probably threw up just about every evening after my shift. Sorry for the gross out factor, but it is pretty grueling having so much responsibility thrown on our shoulders. One day you are a student nurse and it seems like the next you ARE the nurse. I was sooooo BLESSED!!! Every day that I cried, and felt overwhelmed, He was there. I didn't realize all the Blessings I had received (my own little forest).... and because of the HIPPA laws I can't tell you what some of the issues that I came across were. Just that I was, and am, really really Blessed by God!!!! There is a reason why nursing is said to be a "calling" from God. Nursing school brochures do a lot to "romance" the position of the RN with all the technical skills you will obtain, how you will always have a job blah de blah blah blah. But when you get right down to the basics, it takes a lot humility, a lot of courage and His guiding hand to care for another person through their most difficult, or most precious, times. You have to know when to "blend into the background" and when to "take the lead" in the journey.
I've found some of the most honorable moments for me as an RN, and as a person, have been when my patient's illness was terminal. These patients, and their families, revealed what being a nurse is all about. It's difficult to put into words, how great an impact caring for these people have been to me. I have always been a "hand holder" in my practice. There seems to be some reassurance in hand holding..... and I admit, sometimes the patient was reassuring me! I now know that He was relaying that spiritual touch through me, or to me.
I've always believed that we are both "teacher" and "student". For me the teaching/learning moments sometimes have blended edges. For I may go into the moment thinking I am teaching and end up with the lesson! The intensity of love has never been more pure to me than when someone is born or when someone dies. This passing from one state into the next is the most intense and pure thing I've ever witnessed. It's a moment that can bring catches you off guard, tears come to your eyes and time just ....pauses..... it just stops, if ever so briefly. One moment in time and you know life for this family is forever changed . It's like watching the second hand on a clock... with each second, your brain wraps around the auditory "click, the swift visual movement from one dot to the next on the clock face. Time is invisible yet palpable..... you just "feel" it. When watching someone take what is their few remaining earthly breaths, you find yourself holding your own, almost willing the the oxygen to flow from your own lungs to theirs. I'm ashamed to admit there were times that I looked at the clock and thought "not on my shift".... only X amount of time and this will not be on MY shift!!!!! I didn't know it at the time, but it never was on MY shift.... it was on His. I experienced these incredibly powerful gifts at the time when He needed to give them...to me, to my patients, to their families, to my co-workers, to my family ...to everyone that needed to receive them. You see there isn't anywhere in a hospital where He isn't providing something. You may be there as a patient or as a healer, in one minute your are one, then the other. God is the Healer of all things. His love shines through and He knows our plan before we even get a brief thought of it I truly feel that God Blessed me with the gift of service to Him even in my own ignorance . During these most intimate of moments, words are not needed, a gentle touch, a hand held and His love is passed from one to another. I am so thankful that He Blessed me with each and every person in my care. Though I didn't know it then, these gifts will last me through this lifetime and I truly believe, into my next. I testify that these things are true and in His Glory.
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