August, 2008 Archive

i was going to blog about the fact that i have noticed something about myself that completely threw me off the wall. then i stumbled upon this post by beth over at pixel RN, and i decided to stop talking about ME, because as we all know, that is not so interesting.

anyway, the supposed intellectualization of nursing.
that sounds like a topic i should not really put my nose into. if you have been dropping by this little blog for awhile, you probably already figured out that i usually just talk about my experiences and how those experiences affect me either in a positive or a negative way.

beth, i completely agree with you that it is a disservice to the future nurses to give them the idea that they will, when they become RNs enter a job that will only involve their autonomy and intellect, just to find out that isn’t the case. after all, when they work at the bedside, they will be expected to look, smell, and eventually clean up vomit and poop just like everybody else.

but if i may disagree, i will point out that i won’t consider what you do in the recovery room as something that does not involve autonomy and intellectual skills. i could be wrong, but i think the reason why you feel that way is because everything has been so routine and common to you. when you think it over, you will realize that a person without your nursing education, training and experience cannot do your work, no matter how simple it is for you, with the same confidence and competence you have, because you practice with that knowledge that backs your actions up.

can you imagine pulling out some random person from the street to watch a patient recovering after a surgery? will that be the same as paying a registered nurse to do it? if you define autonomy as being capable of being left alone to care for recovering patients with the possibility of going bad, and knowing exactly what you were supposed to do even if the doctors are not around, i think you are autonomous. and intelligence? i think you’ll agree with me that it takes more than a set of eyes, a nose, ears, and a pair of hands to assure that the patients are safely recovering.

going back to nursing education of today, i have nothing against pushing students to embrace the idea that a job in nursing requires them to have that certain amount of brain cells, and that they are expected to use them in their future jobs. i think that every profession are gearing that way. it is some kind of a proof that the profession is evolving, and that education is moving forward. it doesn’t bother me that instructors are hyped up about nursing theories and what not, because those theories are important.

what concerns me is the imbalance. if i went to nursing school and was taught that i need to develop ONLY my intellectual skills, i am screwed. there is no such thing, and it will be an ugly scenario for me to dive into bedisde nursing with that expectation.

i have seen new graduates behave like they were on the floor only to question a doctor’s orders and analyze test and lab results like they were expected to change the treatment plan that the attending has in mind. they look the other way when the call light is on and if the patients need bedpans or emesis basin. they don’t say it, but the look on their faces imply that all those gooey “dirty” stuff are not their responsibilities. i could be wrong, but i think nurses with this kind of attitude, whether new or veteran, are misguided.

on the other hand, i have seen nurses, both new and veterans, who act like they are only on the floor to clean up patients’ mess and never question an order or look up test and lab results because it is not their responsibility. they behave like doctors’ blind followers who do not have a mind of their own, and are not confident enough to suggest interventions, afraid that they will not be heard. i could be wrong, but i also think these nurses are dangerous.

where is the balance?

head. hands. heart.
this is the spirit and core of nursing.
this is the definition of nursing.
being an effective nurse is using all three, having all three.
to be effective is to have that balance.
an effective nurse IS a good nurse.

i have mentioned this in a post a long time ago, as i learned it in nursing school, and i will say it again. we cannot work with just our head, overruled by theories and scientific explanations we memorized and understood in universities and act like we do not have hands therefore we are not supposed to clean up poop. it is not enough that we know what a dirty behind can do to a patient. it is not enough that we have the hands to keep them clean. if we are rough and impersonal, not valuing a patient’s privacy because we think keeping them clean is enough, we are wrong.

we have to know what to do, why we are doing it, and how do we do it.
missing one concept is a disadvantage to our patients.
teaching nursing students, who will be nurses of the future, to focus only on one is not right, and it is dangerous.

nursing is head on, hands on, heart on. all together. all at once.
maybe that is enough explanation why there is a nursing shortage.
it is because not a lot of people can be all that, all at once.

smart people who know every pathophysiological explanation for every disease process but can’t be bothered by unimportant nonintellectual things like changing dirty sheets and cleaning gunky teeth or dentures are probably not cut for it. they will be financially compensated but will never be satisfied.

people with a lot of initiative changing gowns, diapers, and keeping the patient’s environment spotless but do not think twice in giving lasix to a patient with a blood pressure of 70/40 are probably not cut for it. they will be very produtive but will never be efficient.

people who are smart and are hands on who make sure the patients are stable and the orders are unquestionable but do not have time to really listen and show compassion are probably not cut for it. they will always be efficient, but will never feel rewarded.

it is hard to be all that all at once.
very hard.

i know that, because to be honest, i cannot say that i am all that, all at once, all the time.
i keep trying, i keep learning. we all keep trying, we all keep learning.

we have to, because beth’s hanging question is universal, straightforward, and clear.
if no one’s going to do it, who will?

i never thought i’d say it, but last night, i did.
as always, i’m sort of beating myself up for saying it, but what can i do, i can’t take my words back.

one of my patients was having DT, and by far, he has exceeded every encounter i had with expletives. he has called me every unacceptable name in the book, including fat face and pig face. he started, ended, and elaborated his every sentence with the F word, i just got tired of cringing.

at 2000, his repeat potassium was still low, so the doctor ordered two doses of potassium tablets. if you have taken or seen those things, they are humongous! i cut two in halves and offered it to him after convincing him that he badly needed it. he did take the tablets in between cursing and yelling for me to get the f#*k out of there. he started chewing the tablets, and i imagined how bitter it was, so i offered him apple juice, which, to my surprise, he sipped without argument.

when he started gargling the juice, i should have taken the hint, but sometimes, to my disadvantage, i have too much trust in humanity, even for people like him who was logically out of logic. he looked away, i breathed a sigh of relief, expecting he was swallowing. it was too late when i realized that he was aiming his lips directly at my face. with all the strength he could muster, he spit the chewed KCl and apple juice mixture. most of it went to my scrub, but my face wasn’t spared. he then belted out a devilish laugh and said ” i told you to get the f#*k out of here, didn’t i?” then he started kicking, missing the doctor’s chest by an inch, because she pulled away by instinct.

giving in to the frustration that had been building up in the past hours, i wiped the goo off my face, stopped myself from crying out of frustration, and said “i am not paid enough to do this job!”

words, that in a million years, i have never imagined i will ever ever say for real. you know, like i really mean it. and last night, i really meant it.

i did, and though i hate to admit that i am one of those stereotypical guilt ridden christians, i would be lying if i say i do not regret saying it.

anyway, it’s past now, and there is no way i can take it back. it made me wonder if this sudden change in behavior is a sign that  i am not cut for the bedside nursing challenges anymore. if my patience quotient has reached it limits and i am now devoid of compassion that i should seriously consider other nursing options, those that do not involve dealing with confused patients.

i’m just reflecting, just wondering outloud.

she eyed me with a look that made me feel uncomfortable.

i felt like running out of the room, but unfortunately, her husband was not finished embarassing me. he continued elaborating on how great i was, and how i really took care of him.

she tried to stop him mid sentence and asked him if he needed this or that. unfortunately, her husband won’t stop. he continued by enumerating the list of specific things i’ve done that just made his night.

finally, i saw a window of a very short and awkward silence. i said my goodbye very softly, and left the room.

i have been in too many awkward situations as a nurse. nothing beats being praised to the roof like you’re some angel from heaven, while the patient’s spouse is silent, sitting there with a look that speaks volumes. i know the look of gratitude, i’m too familiar with it. there is the other look though, i do not know exactly what it is, but sometimes, it almost looks like jealousy, although i could be wrong. who knows?

male patients especially. their partners/wives/girlfriends get so hyped up about the whole thing like they feel guilty or something for leaving their man to be taken care of my some total stranger. or they feel threatened because their men is taken care of by another woman. i do understand the awkward feeling, but sometimes, it gets way too uncomfortable. they don’t say it, but silence speaks louder. or when they say something, it makes matters worse and maginifies the already awkward situation.

i remember one wife actually asked her husband ”why didn’t you call me?” when he was telling her, in front of me, how  gentle i was when i placed the foley catheter, in the middle of the night, and he finally felt relief after seeing one liter of urine filling up the bag. like i am this husband stealing nurse who can’t keep my hands off her man, at his weakest moments. i was thrown this look that seemed to ask ”why do you have to be so gentle?”

i wish i have the guts to spit it out and tell these women that really, it’s not about me taking their place. i do not change their husband’s gown in the middle of the night so i can get his attention and win his heart. i am totally aware i do not have that charisma, and i am completely conscious of the fact that this is just one of those things i do in my job. 

if you ask me, most of the times it’s just the dilaudid. their men are high on drugs that make them think their nurses should be worshipped. they go on and on and on because they are under the influence.

half of the time, it’s the fact that men and their private parts and body fluids being seen and touched by other women is something very new to them, they don’t know how to react to the whole idea. i personally think it is nothing personal or phycsical. it’s just that he gets to see this person who cleaned his behind and  penis, and he is grateful and has nothing but respect towards her, but doesn’t really know how to say it in a way that won’t sound uncomfortable.

i am not taking the whole situation lightly. i’m pretty sure my husband wouldn’t know how to react around women he only knew by name touching his private parts because he needed help. but as a nurse, i think nothing of it. i seriously have not touched and cleaned a man’s body and private parts and thought “wow we should get together when he’s better”.

seriously. it’s nothing personal/sexual to me. after 15 years of being a nurse, more than 10 years of it spent at the bedside, it’s probably safe for me to say that i have seen/touched/cleaned maybe hundreds of penises, and not even once have i done that task beyond the definition of professionalism. i can’t speak for patients who have erections during the process, but for my own benefit, i consider it as an involuntary physiological reaction. end of story. and i don’t get in trouble.

i’ve been going on and on. too long that this post is almost getting pointless.

i guess what i’m just trying to say is this: men, do not place your wives/girlfriends in an awkward position. it is okay to say thank you, but to linger and elaborate on the tiniest details of what happened during the night was between you and me, and keeping it that way will make things much more uncomplicated. not that it should be kept a secret, but let’s put it this way: your significant other doesn’t really have to know how gentle i was when i was cleaning your private parts. for us ladies, that is way too much information.

and ladies, i understand where you’re coming from with the glaring or uncomfortable glances, i really do. i just hope you find peace in the fact that i have no personal or romantic intentions with your man, and i am just doing my job. i know that sounds unreal when he is constantly talking about how i gently washed his vomit off his chest or rubbed his back to give him a little comfort. those acts may feel way too personal for you to picture, but believe me, i treat your man as a patient who is a human being, in a professional way.

nothing more. nothing less.

this is not a complaint. just a statement.

my back hurt when i helped, twice, with our 518 pounds patient a few nights ago. the six of us, to place the bedpan underneath her, and the six of us to take it out and clean her.

in all honesty, i do not hate morbidly obese patients. i have two very specific feelings everytime i help them or take care of them myself. the first is sadness, the second is fear, never hatred. sadness because i cannot imagine how these patients live their lives productively and independently. fear because what if i continue to fail in my weight loss efforts, never lose that extra 40 pounds, and i end up being one of them, dependent and embarassed, because of my weight?

she was pleasant and very appreciative, but as we wipe our sweat after helping her, words were not needed to express her shame. as she thanked us profusely, looking away embarassed, i just wanted to hug her.

i am not being overly dramatic. i don’t know why i am not immuned from falling into one of my ponder moments everytime i encounter patients like her, considering i see them quite often. i think it makes my job harder, that i always go home feeling heavy after a shift like that, and it doesn’t make matters easier when i finally notice that my back hurts.

so much for work. this is not supposed to be a post of whine.

anyway, last saturday, i turned 39. when i was a teenager, i thought of people who were 39 as people who were really really ancient and were supposed to be displayed in a museum. well, look who’s talking now.

my coworkers thought i was being sarcastic when they greeted me and i answered: “one more year and my life will begin!” i don’t know if i am repressing depressive thoughts because i am growing old, but i do look forward to turning 40 next year just to see if that old line “life begins at 40″ is true.  they said my optimism is sickening because i am happily ignoring the fact that that line is totally untrue, and the real deal is “it’s all downhill from 40″.

i don’t know, i’ve always been a “the glass is half full” kind of gal. which reminds me…sincere thanks to those who expressed positive comments on my fictional stories. in my dream i am a writer. too bad i always wake up

okay, i’m off to have a massage, pamper my old creaking bones, rejuvenate my battered body. you’ll agree with me when i say i totally deserve it, right?