Look at your labs

You have drawn blood, or phlebotomy has come and drawn blood for you. Great. Labs are sent and you go on about your shift. The lab doesn’t call you with any critical values so you figure things must be ok.

And then your patient starts to have more ectopy. His rhythm has definitely changed. Or maybe her blood pressure seems to be lower than normal. Maybe he is more altered than he was.

What’s going on?! This doesn’t make sense. Then you look at your labs… Four hours later…

The values weren’t critical but they are abnormal for your patient. His potassium is 2.9. Her H/H is 7/21, a full three points lower than it was on her last set. His glucose is 61 and he normally runs in the 200’s.

Oh. Ohhhhhh…. Well, shit.

That is four hours that your patient has had abnormal but totally treatable lab values. That is four hours of treatment that your patient did not receive. That is four hours too long. When you send labs or have labs sent for you, you need to remember to check the results. Do not assume that the lab will call you if something is wrong. The lab is responsible for calling when the values are critical or dramatically different than the previous set. However, for some patients, it does not take a critical value for them to exhibit changes. Each person is different, while a hemoglobin and hematocrit of 7/21 may be totally fine for one patient it may be too low for another. One patient may function totally fine with a glucose of 61 while someone that lives higher may exhibit altered mental status. This patient may show no signs at all that their potassium is 2.9 while that patient begins to throw all the ectopy EVER whenever their potassium is less than 3.3. Each patient is an individual and should be treated as such.

Your patient and their labs are your responsibility. Take the minute to give them a check, that minute could save a life.

I don’t have to like you

I don’t have to like you.

You got drunk, got behind the wheel of a car, killed someone.

You lived. You made the mistake and you lived.

I don’t have to like you. I don’t have to be nice to you. I have to treat you.

Remember that.

Sincerely,

Your nurse.

Story time no. 8

I decided to actually check my work mail box. Amongst the numerous papers that I’ve totally ignored I found lots of little shout outs and even a few gift cards from patients and coworkers.

I don’t think people realize just how much little things like this mean. It makes us feel appreciated. It makes me feel appreciated. It shows me that I’m doing something right…

Dear medical student…

Dear med student,

Hi. I’m the nurse that had been taking care of this patient for the last 12 hours. I am the nurse that charted every med given or not given over this shift. I’m the nurse that verified all those vital signs. I’m the nurse that put in that progress note last night. I drew the labs this morning. Yes, I know my patient.

You do not. That’s ok.

While I do not mind you asking me about my assessment, I will not do your assessment for you. You need to check the pupils. You need to check a neuro status. You need to check the lab results. You need to look over the vital signs. You need to look at the meds. You need to know this patient so that you can give your information during rounds.

Walk in. Introduce yourself to the patient and I, the nurse. Put on your gloves and get hands on. Ask questions, we don’t mind. We nurses understand that you are still trying to get your footing. We were there at one time as well.

Understand that ultimately, you still have to assess your patient yourself. Take these moments to build your communication and assessment skills. Each moment of patient contact is a potential moment for learning. Get all up in there!

DNR vs Comfort Care

I have heard DNR and comfort care used interchangeably, especially by doctors. One is not the other!

DNR: Do not resuscitate. It is exactly what it says, you do not try life-saving measures in the event of a code situation. This does not imply that you stop caring for a patient. DNR does not mean “do not treat”! You will continue to provide patient care. You will hang medications for their blood pressure if it is dangerously low. You will more than likely continue to draw labs as well. You will still treat this patient pretty much like any other unless the patient, or their medical POA (power of attorney), tells you otherwise. One thing you must be aware of is whether or not the patient has exceptions to their DNR. Some may say that in the event of a code they want code medications but no chest compressions or intubation. Some people may say meds and intubation are fine but no chest compressions. I have even seen meds and compressions but no intubation (which leaves you wondering but hey, it’s what they want.)

Comfort Care: This is what most people think a DNR is. Just keep them comfortable until they pass on their own. At this point, you are no longer going to escalate care. In fact, you will more than likely begin to scale back dramatically the amount of care you provide. Typically the only medications you will give will be pain medications like morphine and maybe a few breathing treatments to help ease their work of breathing. For the most part, you are there as support for the family if needed, and to assure that your patient dies with dignity.

Please, for the sake of your patient, understand the difference. If you need to clarify with the patient or POA then do so. You don’t want to wait until the patient is near death to try and figure out what the patient actually wants.

Story time no. 7

Had my follow up appointment for my back today. The MRI shows I definitely herniated a disc between the lumbar/sacral region. No nerve involvement so no surgery. Yet. However, if the disc continues to degrade then surgery is where we are headed.

So now this puts me in a weird mental space. Do I continue being a bedside nurse, knowing that I’m going to potentially hurt my back more, or is it time for that cushy office job where I’m not pulling patients? I love direct patient care. I love being at the bedside. My back, however, is not in agreement. I’m a trauma nurse, I’m going to be pulling and tugging. It’s inevitable. My coworkers have been AMAZING at trying to help me out when they see my back is causing me pain. They opt to take the “pulling side” when we turn so I don’t have to strain myself. They put me at the head of the bed holding c-spine so I’m not having to do a whole lot. They have really “had my back” so to speak.

But it’s not fair to them. They shouldn’t have to potentially hurt themselves so I don’t hurt my self any further. I’m starting to feel like a burden. I don’t like that.

So now it’s time to make some big decisions…

Racism doesn’t stop because they are sick.

I am a nurse. I am a proud nurse. I am a proud BLACK nurse. I have never refused to treat someone because of the color of their skin. I have had patients refuse me as their nurse because of the color of my skin.

Racism doesn’t stop because someone is sick. 

I have been called a “black bitch”, “nigger”, reduced to “that colored girl”. I have had patients assume I am “the help” and ask for me to send in their “real nurse”. I have had patients assume I can’t be the one in charge because I am black and “black people can’t be in charge”. I still gave them the best care because I am a nurse, a damn good one at that.

When I decided to enter this field I knew that it would not be all hand-holding and smiles, regardless of what the NCLEX would have me believe. I knew there would be struggles. I knew there would be moments when I question whether I am strong enough. I knew I would question whether I am smart enough. I understood how intense nursing would be. I did not think I would be held to a different standard because of the color of my skin. I did not think that even at their sickest moment a racist would still be a racist. Call me naive. I assumed that if someone was dying they wouldn’t care who saved them. I was wrong. Racism runs deep. Hatred is ingrained into their souls. It is who they are. That level of ignorance is all they know.

I cannot take their stupidity to heart. My skin is not a cloak of shame but a badge of honor. I carry the strength of ancestors that have endured and survived hell, I am proud of that.  My skin does not have anything to do with my nursing abilities. My skin does not make me more or less of a person or nurse than anyone else. I am a good nurse because I make the effort to be. I continue to learn and grow because nursing never stops changing. Racism cannot stop me. Racism will not stop me. Racism will make me bring the pain meds a lot slower though…