So, I tell myself I'm not super-nurse and I can't do it all. I think that is a healthy mantra to carry over to our real lives as well. I never thought that I'd be applying my nursing self care to my personal self care. I feel like my personal self care pre-dates my nursing career and is usually more developed. However, I really like thinking that it is a two way street. So just as I am not a super-nurse, I am also not super-woman or super-human.
Sometimes, just realizing something and being ok with it is the beginning. I like to think that I am kind to myself and I am doing the best that I can do. So having realistic work expectations, means I should really have realistic out-of-work expectations too. I do not want to come home from work and start my homework but it has to happen sometime. So I am not super-student, but I am doing the best I can do, when I can do it and that is just fine.
What other work self cares can I translate to my personal life. Building strong relationships I find to be a work self care, that I am good at in my personal life as well. However, this year it has been hard to give the same amount of energy to my friendships as I have much less free available time. So maybe prioritizing this will give me the extra nudge to not leave my friends out in the cold.
I had a funny practice in not getting really frustrated at work recently. A patient on our floor gave their nurse a $60 gift card to Tully's and told her to buy the whole floor coffee on her. This was really sweet, so the nurse gathered everyone's orders. She asked me what I wanted and I told her I was actually just about to head to Tully's downstairs. I had a student with me so she asked if the two of us wouldn't mind to fill the orders and carry them back upstairs. I told her I didn't mind at all. So me and Alex, the student head downstairs. We start filling the orders at Tully's, there were 13 coffees to be precise. It took awhile for each order to be written on each cup, so by the time we got to the end of the ordering, half of the coffees were already made. The cashier then rang up the order and I gave her the gift card. She proceeded to tell me that the gift card had no money on it! What was I supposed to do? They were mostly made and there was no gift money. So I paid for all 13 coffees with my own money. I was first really frustrated at the nurse who asked me to fill the order, I felt like it should be her going through this scenario, as it wasn't even my idea in the first place. Then I got annoyed at myself for not checking the gift card first. In the end we carried all 13 coffees upstairs and I explained to everyone what happened. I now have 13 people who want to buy me coffee, we'll see if it really happens. But, it was great practice in letting go of a situation that is kind of out of your control.
Navigating crazy situations is a skill I feel I have learned at work. Whether I am now a more patient or less patient person I think is debatable. This is a self-care skill that I think I have perfected at work and hopefully translates into my personal life as well.
Friday, February 21, 2014
Australia, US Virgin Islands, France?
So my international travel nursing quest continues. To be honest I'm glad that I'm not in a rush to go anywhere because it is not easy. I have come across more websites with more options and I am starting to think that going through an agency is easier than trying to set up an actual job placement on my own.
Premier Healthcare Professionals is another website I found that does placement in Australia, the UK and South Africa- all English speaking countries. The contracts are all for 1 year... Which begs the question of how long do I want to live abroad for in one country. I was thinking a 6 month contract would be ideal. So the quest continues.
World Wide Staffing- Not exactly living up to its name has a handful of international placement options including the US Virgin Islands, which could be tempting and I honestly never thought of going to a US Island Territory?! Would one go stir crazy living on an island, these are all important things to think about when contemplating the future.
Then I found a place called the English Clinic in Southern France. It is run by a handful of UK staff that provide English language care. I am very intrigued. Their website is http://theenglishclinic.fr/ Even if I could not work there for money, I would still love to perhaps try volunteer? I have a fair number of relatives that live in Southern France, in Nice specifically. Maybe they could also be helpful in identifying any English speaking options that they know of?!
Like I said earlier, I am really glad I am not going anywhere anytime soon! I am starting to see why people volunteer on mission trips. Coordinating work visas and taxes sounds complicated. I am up for all of it, but it sounds like a lot of personal investigation work is necessary. There is not one clear agency and not one easy country to travel to.
Has anyone heard of Medecins Sans Frontiers (Doctors without Borders), I assume you all have as they seem to be pretty prominent. This is yet I suppose another option of working/volunteering as a nurse in a foreign country. While a different vein than working in an international hospital, it is another aspect of international nursing that shouldn't be forgotten!
Thanks for listening to my rant. It is interesting, yet not particularly straight-forward. I'm sensing lots of time researching and creativity could lead to some very interesting adventures.
Premier Healthcare Professionals is another website I found that does placement in Australia, the UK and South Africa- all English speaking countries. The contracts are all for 1 year... Which begs the question of how long do I want to live abroad for in one country. I was thinking a 6 month contract would be ideal. So the quest continues.
World Wide Staffing- Not exactly living up to its name has a handful of international placement options including the US Virgin Islands, which could be tempting and I honestly never thought of going to a US Island Territory?! Would one go stir crazy living on an island, these are all important things to think about when contemplating the future.
Then I found a place called the English Clinic in Southern France. It is run by a handful of UK staff that provide English language care. I am very intrigued. Their website is http://theenglishclinic.fr/ Even if I could not work there for money, I would still love to perhaps try volunteer? I have a fair number of relatives that live in Southern France, in Nice specifically. Maybe they could also be helpful in identifying any English speaking options that they know of?!
Like I said earlier, I am really glad I am not going anywhere anytime soon! I am starting to see why people volunteer on mission trips. Coordinating work visas and taxes sounds complicated. I am up for all of it, but it sounds like a lot of personal investigation work is necessary. There is not one clear agency and not one easy country to travel to.
Has anyone heard of Medecins Sans Frontiers (Doctors without Borders), I assume you all have as they seem to be pretty prominent. This is yet I suppose another option of working/volunteering as a nurse in a foreign country. While a different vein than working in an international hospital, it is another aspect of international nursing that shouldn't be forgotten!
Thanks for listening to my rant. It is interesting, yet not particularly straight-forward. I'm sensing lots of time researching and creativity could lead to some very interesting adventures.
Thursday, February 20, 2014
Backyard Beauty
Over the past year we have put in a lot of effort to our front and backyard. So, I thought what better place to spend my peaceful outdoor time than sitting in my own backyard. As I step outside it is a pleasant crisp, yet sunny day. There are birds chirping all around me. I love hearing the many different types of bird calls. Even though I can not see them, I know they are sitting up in the trees around me.
First I take it all in, and then I get curious to wander around. Last Spring we tore up the moss that covered all our flat yard space and planted grass seed. It rains so much in Seattle that I don't feel bad having a lawn (growing up in California with droughts, lawns are a unnecessary sucking of water resources). The grass is nice and fresh green color and smells sweet. First I peek at our garden boxes.
First I take it all in, and then I get curious to wander around. Last Spring we tore up the moss that covered all our flat yard space and planted grass seed. It rains so much in Seattle that I don't feel bad having a lawn (growing up in California with droughts, lawns are a unnecessary sucking of water resources). The grass is nice and fresh green color and smells sweet. First I peek at our garden boxes.
In the fall I covered the boxes with leaves and mulched them into the dirt. I am curious if anything is growing back. I always find it peaceful seeing the garden boxes resting, full of potential for the summer planting. I like the symbolism in that image. I like thinking that I am resting and rejuvenating all winter long as well (fewer leaves were required in my winterization). I look close and I see little glimmers of growth peeking out of the dirt and leaves.
Can you see the little shoots coming back! Pictured from the left to right is flat leaf parsley, thyme, and chives. I love being in the fresh air, seeing the sun peeking out behind the clouds. As it is 11am on a weekday while I'm outside, there is no one else really around. My neighbor's kids are at school and my neighbor's themselves are at work, so I feel like the world around me is all mine.
And finally as I walk around the corner, I notice our Camelia tree is budding. There is so much beauty present in the few hundred square feet of our backyard it reminds you how much beauty there is in the world in general. Sometimes you have to look closer and then it becomes clear. I am grateful to be able to be able to immerse myself in all this fresh air and plant life. I love being able to plant flowers and veggies and see their progress over the years and seasons. These are reflections of what I think is beautiful!
Saturday, February 15, 2014
The sheath
Ok, so I'll vent a little bit...
I think the reason I have this deep seated dislike of sheath pulls is once you're in, you're in. Here's what I mean. If you are able to pull the sheath (out of the femoral artery after stent placement) you are then responsible to do it for the entire hospital. The time that I would need to do this role is only when I am charge nurse and there is no one else available to do it- and I just don't like that.
Our floor has the cardiac resource nurse, that is their main responsibility it pulling these sheaths around the hospital- they are some of my favorite people. However, they are currently not staffed on Sunday's, work 8 hr shifts, and can call in sick too. Therefore, there are many times when the charge nurse has to pull the sheath. I do not like being charge nurse and having to go to the ICU pulling a sheath there, then having to go the the Med-Tele unit and pull a sheath there... I find it to be draining as well as doing all the other responsibilities of charge.
If you look at the nurses who have left our floor for outside jobs or other units at Virginia Mason, lots of them have been prior charge nurses- responsible for pulling sheaths. I don't want to wear out my patience with my floor. Therefore, I generally try to avoid being in this situation.
The other way that stents are placed is through the radial artery, these I actually enjoy managing. Most of the new Interventionalist's that VM hires prefer the radial approach. However, in time of STEMI the groin is always used. And... as we are a cardiac floor we are no strangers to the STEMI.
Since I really do like thinking of myself as a totally competent cardiac nurse and have every opportunity to learn how to be a good sheath puller- in the future I want to tackle this topic. Maybe once we finish our BSN then I will try embracing the role of sheath pull. Because I want to keep learning new things and expanding my role as an RN, I suppose I could some day step and volunteer as a resource nurse. I feel like I would have a lot of respect for myself the day that happens. In the meantime, I will kind of side step and kind of mentally prepare.
I think one other reason I dislike sheath pulls is there are so many variables and sometimes I worry about keeping them all straight. So maybe I need a good old-fashioned chart and a refresher day with the anti-coagulation machine. Depending which anti-coagulant the patient got in the cath lab we have to check their ACT- activated clotting time. But in order to check the ACT you have to put three- no more and no less, drops of blood in this little piece of plastic and enter all the various data into the machine.... But every few days the machine has to be recalibrated so there is another step I need a refresher class on too:)
Long story short that it the honest answer of why I do not like pulling sheaths. I look forward to someday embracing it head on, in the mean time I'll keep slowly trying to come around.
I think the reason I have this deep seated dislike of sheath pulls is once you're in, you're in. Here's what I mean. If you are able to pull the sheath (out of the femoral artery after stent placement) you are then responsible to do it for the entire hospital. The time that I would need to do this role is only when I am charge nurse and there is no one else available to do it- and I just don't like that.
Our floor has the cardiac resource nurse, that is their main responsibility it pulling these sheaths around the hospital- they are some of my favorite people. However, they are currently not staffed on Sunday's, work 8 hr shifts, and can call in sick too. Therefore, there are many times when the charge nurse has to pull the sheath. I do not like being charge nurse and having to go to the ICU pulling a sheath there, then having to go the the Med-Tele unit and pull a sheath there... I find it to be draining as well as doing all the other responsibilities of charge.
If you look at the nurses who have left our floor for outside jobs or other units at Virginia Mason, lots of them have been prior charge nurses- responsible for pulling sheaths. I don't want to wear out my patience with my floor. Therefore, I generally try to avoid being in this situation.
The other way that stents are placed is through the radial artery, these I actually enjoy managing. Most of the new Interventionalist's that VM hires prefer the radial approach. However, in time of STEMI the groin is always used. And... as we are a cardiac floor we are no strangers to the STEMI.
Since I really do like thinking of myself as a totally competent cardiac nurse and have every opportunity to learn how to be a good sheath puller- in the future I want to tackle this topic. Maybe once we finish our BSN then I will try embracing the role of sheath pull. Because I want to keep learning new things and expanding my role as an RN, I suppose I could some day step and volunteer as a resource nurse. I feel like I would have a lot of respect for myself the day that happens. In the meantime, I will kind of side step and kind of mentally prepare.
I think one other reason I dislike sheath pulls is there are so many variables and sometimes I worry about keeping them all straight. So maybe I need a good old-fashioned chart and a refresher day with the anti-coagulation machine. Depending which anti-coagulant the patient got in the cath lab we have to check their ACT- activated clotting time. But in order to check the ACT you have to put three- no more and no less, drops of blood in this little piece of plastic and enter all the various data into the machine.... But every few days the machine has to be recalibrated so there is another step I need a refresher class on too:)
Long story short that it the honest answer of why I do not like pulling sheaths. I look forward to someday embracing it head on, in the mean time I'll keep slowly trying to come around.
Friday, February 14, 2014
Framework II
I'll use the Gibbs Model to analyze a second incident at work...
Recently I had a patient transferred to our floor from an outside hospital for pre-bypass surgery. He came to us with a heparin drip running, but it was the medics bag, with tubing that is incompatible with our IV pumps, and at a different concentration than we stock. This is always a sticky situation, and there is not a lot of guidelines that we have for this. I was charge nurse, so the patient's nurse and I turn off the heparin drip and page the accepting doctor listed. He is not a usual heart surgeon that we work with instead he is part of a cover team if one of our regulars is out of town.
So I page the doctor listed asking for heparin orders. He calls the floor back and tells our unit secretary for me to page the "210". "210" means nothing to me, it is not part of our usual language. So I am forced to re-page him and ask for clarification, since he will not put in the heparin orders. He calls back again this time frustrated and tells me this always happens. I have enough insight to realize this situation is a little bit bigger than just me if it happens each time. I ask him if he means for me to page the heart surgery resident, he states no the 210! Again, I'm like well that isn't anyone we use here. He then comes to floor to belittle me and ask why I am paging him so many times. Meanwhile it has been over two hours the patient has been on our floor without the heparin drip running. Heparin has a really short half life, so I know most of it is out of his system by now.
Finally, the accepting doctor finds the person he wants to work with- who is the heart surgery resident, that he also thinks should be called the 210. She puts in heparin drip orders and then asks me why we haven't checked his anti-coagulation levels? I tell her we can't do any of that until there is a doctor's orders, which is why I have been paging him. The whole situation felt very circuitous and frustrating, when it did not need to.
I was thinking I am doing the right thing for this patient by requesting repeatedly for the heparin drip to be ordered, but I can't figure out where the resistance is coming from. I know that the short half life of heparin exists so I'm feeling like there is a ticking clock involved in this situation. I also cannot figure out why the doctor just will not put in the order himself?
The good thing about this situation is I emailed my manager that night explaining the situation, because I did not want it coming back poorly on me. I then asked her what we should do in that kind of situation. She told me we should call a MET which is like a rapid response call if it has been over an hour of a patient being on our floor who needs heparin and doesn't have an order. That way there is a doctor at the bedside who has to put in the order. The bad part of this experience is that it did not need to happen, and I felt like the doctor was mad at me for looking out for our patient.
The sense that I make of this situation is that this covering doctor felt out of place (even though he routinely covers at VM). I could have called our house supervisor involved, I felt like it was not the role of the hospital supervisor to deal with one specific patient concern but they might have had some insight. I also could have called our rapid response RN to come assist the floor nurse caring for this man, so she wasn't so busy trying to smooth out the situation.
If anything similar was to happen again and involved a pre-CABG patient, I would page the covering resident even if the MD thought it shouldn't be them. I will let the surgery resident tell me they are not working with that patient, rather than sit and wait for hours. And, now I know what is our floor policy as well if this situation of no heparin order arose again. I always let my manager and assistant nurse manager know if something out of the ordinary happens on my shift, that way they are pre-informed and there are no surprise issues showing up on their desks.
Monday, February 10, 2014
Suffering vs. Not Suffering?
I thought last weeks class discussion about what is suffering and what is not suffering was super interesting. Especially because maybe you would think of 'not suffering' as just the opposite of 'suffering', but is it...? Which leads me back to the topic of self care and how to best not suffer.
Some of my favorite topics of not suffering (that we thought of) was having realistic expectations. The idea of being "super nurse", is some sort of fantasy but not a reality. Sometimes when I come home from work exhausted it is because I have tried to do more than is possible for one human being. I think the self care part is realizing when to say its ok and I'm going to take a break. I struggle with this, as I'm sure so do others. So now I regularly make myself tune out and take a coffee break, and a lunch break, and a pee break... even if part of me is like no don't leave the floor!
I feel embracing this life and work perspective helps me suffer less while at work and especially once I get home too. I think we can all benefit from practicing letting go the idea of being super nurse and instead being able to have a realistic expectation of our work day. This realistic expectation I realize is two fold: one of how much physical work we can actually do, and two how much we mentally hold ourselves responsible for. I would say based on my work experience keeping both in-check are important. So I vow as part of my self care exploration to be easy on my mind and body and set myself up for realistic expectations.
Another part of not suffering is having adequate support. So maybe there is an element of self care in building and tapping into a strong support system?! I love my charge nurses at work, the CNA's, the rapid response nurses and the list goes on. I think remembering all the ways to use them as a daily support system is beneficial. I feel I am a good delegator, pat on the back to me :*) Working as a team with my CNA makes my days at work fly by much more smoothly. Being in contact with my charge and rapid response nurses give me an extra set of brain neurons and hands. Remembering I am not out there alone with my patients gives me some alleviation of suffering.
Adequate support system at home is another extension of self care. This one I have played around with and came to the conclusion (with my fiance Marcus), that our life is much better on days that I work he cooks. He can cook anything he wants, lasagna to cup of noodles so long as it is roughly ready to eat when I get home. We normally love to cook together, however now that I am on day shift this has ended poorly sometimes. The aforementioned lasagna is a favorite dish of ours to cook and his is especially wonderful with leeks and kale mmmm... However, one night upon arriving home hungry and tired he thought it would be fun to go grocery shopping and then assemble and bake the lasagna- something we normally love to do. I agreed using my last bit of energy from the day. Half way through grocery shopping, it's now almost 8:30pm I can feel my belly growl- bowel tones were present in all four quadrants. Then we start cooking and assembling and by the time it's ready to eat it's almost 10pm and I am a hungry mess. Long story short part of my self care and not suffering routine is having something to eat within like a half hour of coming home. Everyone is happy that way and the suffering is minimized. But this works especially well because of the home support system, of a loved one who realizes what works best and how to step up on days when I'm tired from working.
Minimizing suffering and maximizing not suffering is often times about how we view our surroundings. I am trying to actively set myself up as positively as possible because otherwise I think burnout could be eventually inevitable. Realistic expectations and broad support systems are a top priority for me to work on in the near future.
And, on the topic of not suffering, I asked if I could go down in hours as work next quarter. My boss told me it wasn't possible, but I was welcome to use as many vacation days as I need. So next quarter I am going to use a vacation day every other week. I don't need to prove anything to myself or anyone else that I can do it all, instead I am looking out for myself preemptively.
What are your thoughts on suffering vs not suffering at work?
Some of my favorite topics of not suffering (that we thought of) was having realistic expectations. The idea of being "super nurse", is some sort of fantasy but not a reality. Sometimes when I come home from work exhausted it is because I have tried to do more than is possible for one human being. I think the self care part is realizing when to say its ok and I'm going to take a break. I struggle with this, as I'm sure so do others. So now I regularly make myself tune out and take a coffee break, and a lunch break, and a pee break... even if part of me is like no don't leave the floor!
I feel embracing this life and work perspective helps me suffer less while at work and especially once I get home too. I think we can all benefit from practicing letting go the idea of being super nurse and instead being able to have a realistic expectation of our work day. This realistic expectation I realize is two fold: one of how much physical work we can actually do, and two how much we mentally hold ourselves responsible for. I would say based on my work experience keeping both in-check are important. So I vow as part of my self care exploration to be easy on my mind and body and set myself up for realistic expectations.
Another part of not suffering is having adequate support. So maybe there is an element of self care in building and tapping into a strong support system?! I love my charge nurses at work, the CNA's, the rapid response nurses and the list goes on. I think remembering all the ways to use them as a daily support system is beneficial. I feel I am a good delegator, pat on the back to me :*) Working as a team with my CNA makes my days at work fly by much more smoothly. Being in contact with my charge and rapid response nurses give me an extra set of brain neurons and hands. Remembering I am not out there alone with my patients gives me some alleviation of suffering.
Adequate support system at home is another extension of self care. This one I have played around with and came to the conclusion (with my fiance Marcus), that our life is much better on days that I work he cooks. He can cook anything he wants, lasagna to cup of noodles so long as it is roughly ready to eat when I get home. We normally love to cook together, however now that I am on day shift this has ended poorly sometimes. The aforementioned lasagna is a favorite dish of ours to cook and his is especially wonderful with leeks and kale mmmm... However, one night upon arriving home hungry and tired he thought it would be fun to go grocery shopping and then assemble and bake the lasagna- something we normally love to do. I agreed using my last bit of energy from the day. Half way through grocery shopping, it's now almost 8:30pm I can feel my belly growl- bowel tones were present in all four quadrants. Then we start cooking and assembling and by the time it's ready to eat it's almost 10pm and I am a hungry mess. Long story short part of my self care and not suffering routine is having something to eat within like a half hour of coming home. Everyone is happy that way and the suffering is minimized. But this works especially well because of the home support system, of a loved one who realizes what works best and how to step up on days when I'm tired from working.
Minimizing suffering and maximizing not suffering is often times about how we view our surroundings. I am trying to actively set myself up as positively as possible because otherwise I think burnout could be eventually inevitable. Realistic expectations and broad support systems are a top priority for me to work on in the near future.
And, on the topic of not suffering, I asked if I could go down in hours as work next quarter. My boss told me it wasn't possible, but I was welcome to use as many vacation days as I need. So next quarter I am going to use a vacation day every other week. I don't need to prove anything to myself or anyone else that I can do it all, instead I am looking out for myself preemptively.
What are your thoughts on suffering vs not suffering at work?
Saturday, February 1, 2014
The Grass is Greener on the Other Side of the World
One of my goals was to investigate what it takes to work as a nurse internationally. Which for us already living in the United States, means somewhere outside the US. I started my quest like any good seeker and typed www.google.com and searched for "International Travel Nursing". The first site that comes up is called Travel Nursing Central. It draws attention to the fact that perhaps I had been a little ethonocentric... It says most international travel nursing occurs from nurses in other countries wanting employment in the United States. It hadn't exactly occurred to me that I was the opposite of a large trend.
But the site also draws the connection that American nurses often want to nurse abroad for excitement and adventure- even though it usually comes with less pay. And, that is where I feel I have to agree. I am not interested in nursing abroad to make fortunes- rather just to be able to get by and have an adventure. Which is all easy to say, because I will always be welcomed back to the United States as nurse, so there is really quite little risk for me.
The website I started on is http://www.travelnursingcentral.com/members_only/international.htm
It is a surprising wealth of information! And I think sets realistic expectations.
It calls out a few things quickly...
1. Expect about 8 months for getting paperwork in order, this is not a quick dash out of the county.
2. Have all your ducks in a row: Passport, proof of licensure (RN), and visa to another country.
3. Travel nursing to Saudi Arabia and the United Arab Emirates is very doable. While not the top of my travel nursing destinations to be honest- I actually maybe shouldn't be so quick to overlook them?
The site also, lists many English speaking countries and their associated nursing boards. To be honest my two dream places to nurse internationally would be France and New Zealand. Sounds great, to me! I think the key to making this goal feasible is to be open minded. See where I realistically can work abroad and then go visit other places on vacation:)
But the site also draws the connection that American nurses often want to nurse abroad for excitement and adventure- even though it usually comes with less pay. And, that is where I feel I have to agree. I am not interested in nursing abroad to make fortunes- rather just to be able to get by and have an adventure. Which is all easy to say, because I will always be welcomed back to the United States as nurse, so there is really quite little risk for me.
The website I started on is http://www.travelnursingcentral.com/members_only/international.htm
It is a surprising wealth of information! And I think sets realistic expectations.
It calls out a few things quickly...
1. Expect about 8 months for getting paperwork in order, this is not a quick dash out of the county.
2. Have all your ducks in a row: Passport, proof of licensure (RN), and visa to another country.
3. Travel nursing to Saudi Arabia and the United Arab Emirates is very doable. While not the top of my travel nursing destinations to be honest- I actually maybe shouldn't be so quick to overlook them?
The site also, lists many English speaking countries and their associated nursing boards. To be honest my two dream places to nurse internationally would be France and New Zealand. Sounds great, to me! I think the key to making this goal feasible is to be open minded. See where I realistically can work abroad and then go visit other places on vacation:)
Framework
It's 5pm, and my evening as charge nurse is wrapping up. The sun is setting and I have gone to the end of the day meetings. Looking on the computer, I see discharge orders are entered for a confused patient on our floor. I think that's odd because there was no talk of this during the day, so I go find Jennie the nurse. I ask her what she thinks about this and she is just as shocked as I am.
I think to myself, I'll call the doctor and make sense of this situation. I call the doctor, who tells me it is 100% his intention to send this confused patient home- in the dark, with no family support, via taxicab. Using my nursing judgement I know this is unsafe, what if he doesn't have his house keys, how will he pick up his prescription medications tomorrow... the questions start lining up.
The nurse and I get very proactive: we call the listed family contact who say they live out of town and are unable to visit him for a few days. Strike one. We call the social worker in the ED who is still here this time of day, she comes to the floor and agrees we should just wait until the morning to facilitate the discharge. The stories continue to mount... more documents are discovered and ultimately the patient has to be held overnight for an involuntary hold. I felt frustrated as the charge nurse and so did the gentleman's nurse because we spent hours discussing with the MD how we can't just send this elderly man who has no idea who he is or where he is back to his home yet- all while meeting aggressive resistance from the MD.
I like the how straightforward the Stephenson Model (2000) is, so that's the one I'm going to use...
My role in this situation was to oversee the safety of all the patient's on our floor and be a resource for the floor nurses (aka, charge nurse). I felt comfortable arguing our point and getting all the ducks in a row to prove our cause, however I felt very uncomfortable that the doctor was being so resistant. I usually try to see the middle ground and not be a stickler, however our job as nurses is to see the bigger picture and look out for our patient's overall safety- especially if they are not ready to transition back to their home setting yet.
The actions I felt were best to take at this point, was rally as much support for our case to keep him one more night. I contacted the family, contacted the social worker, who ultimately contacted the head Mental Health doctor's at Virginia Mason. Because they were all in agreement with myself and Jennie, the patient's nurse I felt our case was much stronger. I also like that approach because it takes off the head to head tension in which I as the nurse would ultimately loose. As it is the doctor who enters the discharge orders, if I as the nurse don't let the patient go I am detaining a free man against his will. I felt my actions were appropriate without loosing my cool.
I could have improved the situation for myself and my patient by getting the social worker involved immediately. I did not know there was a 24hr social worker in the ED at the beginning of this experience. Now I know that, the next time something fishy comes up that is similar I will call them and ask their input from the beginning. I say this because the social worker has a wealth of other resources and knowledge that they can bring on board. I learned that I feel very protective of my patients. It almost reminded me of a parent looking out for their child. I knew there was no way this man could fill his medication prescriptions, let alone take them as ordered. The thought of sending him home to a life full of unknowns was something I was not ready to let happen on my watch.
Going into this situation I expected a totally different outcome, I expected the doctor to at least listen to my concerns and then be amenable to a morning discharge. This changed my way of thinking as a nurse to being able to put together a case for your cause. I felt like I had to channel and inner lawyer and think what is the best way to win my point. I have never thought of nursing in that way before, but it can be helpful in many situations I'm sure.
I applied my knowledge and theory that our duty as a nurses is to oversee the safety of those we care for. We as nurses spend our 12.5 hour shifts interacting directly with the patient. We know their mentation, their ability for self care, we see the questions they ask, and this is not something to be overlooked. Doctor's have their large role in patient care as well, but they only spend about 20 minutes at each patient's bedside everyday. A broader issue it to continue nurses being empowered to speak up for their patients and to realize the power and knowledge from being at the bedside all day long. I think that is important to emphasize in nursing school, in nursing literature, and throughout the practice. I think the continuous bedside care and relationship is what gives nurses great trust in public opinion and power in the patient care relationship.
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