Nursing convos with non-nursing friends

Guys, I apologize.

I bombard you with all these stories about my hot mess shifts. I rattle off all kinds of medical terminology. I tell you things that probably gross you out because I think it’s cool.

You listen anyway and try to make sense of this shit. You try to keep your questions about the 12 medical abbreviations I just used to a minimum. You participate in the conversation. You are actively listening despite not having a clue what the hell I am talking about.

I’m sorry.

My life is spent around nurses and doctors. We probably use more medical abbreviations that actual words. I have clearly forgotten how to communicate outside of nursing. I throw terms at you, expecting you to catch them the way my colleagues do. Bless you all, you stick with me for a long as possible.

I am going to try and differentiate between friends and coworkers from now on. I will try to speak in layman’s terms. I am going to work on breaking out of the habit of using medical abbreviations. I am going to continue grossing you out though. I’m a nurse, my entire shift is gross. You’re just going to have to suffer through that part with me.

SBAR it!

I used to run EMS. I did it for eight years. We would call report on the radio to the hospital that we were in route to. There is a lot going on in the back of an ambulance so we didn’t have time for “long and elaborate”. We opted for the “short and sweet”. At one of the hospitals I worked at, you had to page the doctor on call for anything you needed. Unlike at level one centers, the doctors have to be available but not actually in house. So imagine having to page at 2:15 in the morning… The doctors where usually tired, angry you paged, and over it before you even picked up the phone to answer their return call. In that moment the docs probably had a two minute attention span so I had better be quick about it. EMS prepared me for the “short and sweet”, the “just the facts ma’am” answer. The doctors seemed to appreciate that.

So what exactly is the SBAR format? How is it beneficial when talking to the doctor in response to a patient?

Situation- What wrong right now? What happened to make you send the page?

Background- What’s been going on with the patient leading up to the event that makes this a change? A little relevant history of the patient is probably good to add too.

Assessment- What have you noticed about the patient in relation to the change you are paging for?

Recommendation- If appropriate, what do you recommend?

I will put SBAR into use so it makes sense, okay?

It is two in the morning in the ICU. My patient starts to ring on the monitor with a heart rate bouncing around from the 120’s to 140’s. It looks super irregular, kind of like A-fib with RVR. I grab the EKG machine and run an EKG on my patient and sure enough, it is. This is new. Time to page the cardiologist… at two something in the morning… and the doc on call is the one with the worst attitude… Great…

He’s on the phone, let’s do this:

Situation- “I’m calling about Ms. S in room 212. She has suddenly flipped into A-fib with RVR from sinus rhythm.

Background- “She is the patient here for sepsis from infected knee hardware who coded in the OR. She converted to A-fib on the monitor about 10 minutes ago and her blood pressure has dropped with it. I looked back and she doesn’t have a past medical history of A-Fib and she’s been in sinus rhythm and sinus tach since admission and she has been here a week.”

Assessment- “I did an EKG and it is showing Afib with RVR. She is still able to follow commands on the vent even though her pressures have dropped from 130’s over 70’s to 90’s over 50’s.”

Recommendation- “Did you want to start her on the amiodarone bolus and then the amiodarone drip? Also, could I go ahead and get an order for a pressor? She hasn’t dropped super low yet but I would rather have the order just in case she does so I don’t have to page you again.”

That’s it. I have had almost this exact conversation with a cardiologist in the middle of the night. It probably took less than three minutes to get all of that out. It was short enough that instead of attitude, I got the orders I wanted. I recommend giving it a shot the next time you have to send a page to the doctor with the attention span of a two year old and the attitude to match!

(of note, please don’t actually say “Situation” and then start talking. You will sound really weird!)

Your safety matters

It's happening more and more. Medical professionals are being hurt, attacked, even killed while providing care. We go wherever medicine takes us. Caring for others is a part of who we are.

Let's learn to care about ourselves and our safety more. You are not obligated to go into any situation that you feel is unsafe for you. You do not have to deal with the aggressive visitor that has threatened you more than once. You do not have to deal with sexual harassment from your patient. You are not at work to be subjected to physical abuse from your patients. Your safety concerns are valid. You have every right to demand a safe work environment.

If you need to utilize security then do so. If the nursing staff has to be changed because the patient only harasses a particular nurse, then make that change happen. Report threats and take threats that are reported seriously.

Furthermore, be aware of your surroundings. Know where you are in your room in relation to the door. If the situation calls for it, take a second nurse in with you as your "back up". In some hospitals, security can be used to sit with the patient, if the patient is deemed a danger to the staff (the hospital I am at currently does this).

You are important. Know that your safety is important too.

 

Story time no.6

Sitting at the front nursing station when the door rings.

"Delivery for STICU!"

Delivery? It's one in the morning, what the hell is being delivered at one in the…

Oh.

Ohhhhhh…

THE LEECHES!

He's delivering the God forsaken leeches!

I am thoroughly grossed out. I hate leeches. I hate them with every fiber of my being. I can't touch them. I don't even want to look at them… but I need to open the box so we can put the squirmy bastards in their refrigerated tanks.

I managed to open the box. As you can see, I even managed to pick up one of the bags.

That's as far as I got.

Dude was far too squirmy and I was far too grossed out to do anything else with them. God bless our tech for being able to grab the box and take them away from me so she can put them away.

I'm a horrible charge nurse. I'll take that. I'm not touching those bastards though…

Learn to unplug! (Guest post from exit265c.com)

Aside: As someone who can sing the entire Arcade Fire debut EP, it pains me to say I really don’t like Everything Now. At least I’m really excited about the new album by The National because the two songs I’ve heard are promising. Once upon a time, there was a point when I strongly considered […]

via break — EXIT 265C

Speak up when it doesn’t feel right

You are your patient’s last line of defense.  Whether it’s meds, bedside procedures, trips off the unit, or just care in general, you are the person that can potentially save a patient.

I know, medical shows would have you believe that doctors are the saviors. Doctors are the last hope. Doctors save the world! Yeah, most of the doctors I know can’t start an IV sooo…

You are the one at the bedside for 12 hours. You are the one that has had them for three shifts straight and don’t even need report anymore. You are the one that knows that patient. You are the one that may notice something wrong.

Perhaps you come in for your shift and notice that Mr. B, who is typically trying to crawl out of the low bed and get back to his “bus”, it far too chill. His vitals have been great all day. The team doesn’t order labs for him daily anymore but the ones from two days ago look fine. In your gut you know something isn’t right. You talk to the doc, who isn’t impressed. You give it all you got and at least convince the doc to order a set of labs for now. You get those labs and anxiously wait to see if they can help you figure out why Mr. B hasn’t tried to kick you in the face tonight.

And then the lab results come back AND THEY ARE A SHIT SHOW! His WBC’s are almost 30. His H&H has dropped by 3. His BUN and creatinine are climbing. All of his electrolytes are out of wack. But once again, his vitals have been good all day.

You just saved your patient. You knew something wasn’t right, even if you couldn’t pinpoint it. By being a patient advocate you may be the reason he’s alive.

Maybe it’s less dramatic than that. Maybe they have ordered a medication for your patient that seems like it just might be contraindicated at this point. His platelets are low. His INR is going up, not down. One of the teams wants you to give heparin. You aren’t comfortable with that, especially since the primary team (or doc) purposefully stopped it because of his labs. You try and talk to the ordering provider and rather than listen he yells “just do it!“.  Do NOT just do it. Healthcare was not designed by Nike and that rarely works out. You can take another step. You can talk to the primary team or doc about a consulting team or doc restarting what they’ve stopped. So you do just that. Primary agrees with your hesitation and they talk to the consult to let them know heparin has been discontinued and why. Turns out, consult didn’t actually look at any labs before ordering it.

Looks at you walking around saving the day, like you have an “S” on your chest! You know what you are doing. You know when something isn’t quite right. You know your patient. Trust yourself and speak up when you feel like it is necessary.

Story time 5

I rarely, if EVER, read comments on social media. I know better. The amount of hatefulness in the comments is unmeasurable. However, I ran across a post on Instagram showcasing the singer Halsey's thoughts on birth control and why is should be considered health care. She even went on to list the medical conditions that birth control was able to help.

I read the comments.

For the most part the comments were full of women in support of her tweets and sharing stories of their own on how birth control has helped them.

But it wasn't all support. Oh no. There were a few in the comments that wanted the world to know that we, THE ENTIRE FEMALE POPULATION, were stupid for not just taking care of our reproductive issues the "natural way".

Yep. That's the fix. Change your diet and drink a special tea and that'll handle that severe endometriosis and those ovarian cysts you're dealing with.

But there was one lovely person in the comments that couldn't just be happy with condemning your use of meds. Oh no, Cassy_chevy had to condemn YOU!

Awesome. Let's bash any and every person that decides to have a different opinion.

So there you have it ladies. YOU have no idea what YOU are doing with YOUR body.