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Nurses Behind The Scenes

April 9, 2019 0 Comment


As nurses, like other healthcare workers. We play an important role for successful patient outcomes. Nurses are said to be the anchor of the unit, and are capable of functioning in all capacities. We do not prescribe, unless we hold an advanced degree as in the case of the Nurse Practitioners (NP). Nonetheless, we are great advocates, and will make the necessary recommendations to the prescribing provider. For example, a number of times, we have caught the error that would result in a terrible ending or lobby on a patient’s behalf that more needs to be done. Whatever the case, nurses ensure you are taken care of.  We are the caretakers, and grounds men of the unit. Often have to  fix the malfunctioning  equipment necessary to perform our duties,  empty the trash, clean the rooms, order and carry a patient’s meal tray, take it out when they are done eating, in addition to a host of other ‘non- nursing duties’, that were not listed in a job description upon hire. Because of the caring nature of nurses, It is usually not burdensome to go the extra mile.

Going to the extreme is some of the things we do, for great patient satisfaction. Our employers sometime recognize the effort in providing excellent patient care. The positive reviews given by patients after leaving, makes nurses feel even more appreciated. Especially because there really are some awesome nurses in the profession. The caring aspect of nursing is one of the reasons I choose the profession. The pressure we endure is making increasingly difficult to give one hundred percent

In the Emergency Room (ER) setting, one nurse is usually assigned a total of four patients. It could be more or less, depending on the facility. I was astounded when a colleague of mine revealed that at one facility, the assignment was a one nurse (RN) to three patients kind of a deal. But I have also worked ER where my assignment was eight patients high acuity level ER. Regardless of the number of patients assigned, it can be a very overwhelming experience. This is acute care, even trauma is involved at any level. Safe nursing care is frequently checking on our patients. How frequently a patient gets checked on, is primarily based on presenting complaints and clinical presentation. Because patient care is individualized and no two people are the same. There is no age limit to the patients who present, so the very young and the very old may need more attention as well. The four assigned patients need their nurse checking in with them frequently, ensuring they are comfortable, and kept informed at all times. We also make certain prescribed medications and other treatments are not delayed. Time management is very important, therefore we do not want to delay your treatment. Late administration of medications, delayed lab draws will be criticized. The period of time that passes before your nurse checks with you varies. One Key factor in not seeing your nurse frequent your room, is the acuity of the patients assigned. This means, patients are given a level at triage, based on the presenting complaints. This is a numerical level, numbered 1-5. In chronological order, number 1 is the most critical. All patients are important. However, not all patients need the same attention and treatment plan.

When you have not seen your nurse returned for the last hour or so. It likely we are caught up with someone critically ill. For example, having a ventilated patient (Breathing machine). If this the case, then that nurse has an Intensive Care Unit (ICU) patient that needs one on one attention, in an ER setting where the ratio of nurse to patient is 4:1. Think about that.  Sometimes these patients are so critical, that a second nurse is required to assist that nurse, but is not always available. Until this patient is really stabilized, that assigned nurse should not leave the room. If the nurse leaves, and there is a negative outcome, then that nurse is liable. How can this be possible, that nurse has three other patients that need attention. Especially if one of those three falls in a high a acuity level as well, which is common, hopefully not another intubated one. This has been my experience over the more than ten years I have worked as an ER nurse, and it continues. Not being able to check on a patient as often as is necessary is frustrating for both the caregiver and the recipient. This type of situation places anxiety on the already overwhelmed RN. I recall having a exceedingly critical patient, and saw emergency medical technician (EMS) standing outside the room next door, waiting to give me report on a new arrival. Fortunately it was not a serious case. Some patients are experienced and intelligent enough to understand. They will quietly wait their turn, and even apologize for asking for something. Then there are needy ones who will be on the call light the minute you exit the room. I always make sure my patients have the call bell, but I really do not expect it to ringing every 3 minutes, and yes it happens. I understand that people will be different, so it does not really bother me. I will simply return to you as soon as I can. Some patients will have the most ridiculous request, such as a capable person asking me to pull over a blanked to cover them. Or retrieving a charger to plug in a cell phone. While nothing is wrong with wanting a charged cell phone, why not wait a bit until I return to you. It is very easy for a patient to become irate if they feel they are neglected, and that too is understandable.

One experience I will never forget is,  I had a critically ill elderly patient who needed some airway management, and stabilization. I was in that room for approximately two hours, when the ER tech came and told me the patient next door needed me. Having somewhat stabilized my patient, I hurried to see what that patient wanted. To my surprise he needed a urinal. I was silently livid. I certainly can give you a urinal, but did you not see the tech came and answered your light. What makes you thing that only the nurse can hand out the urinal. To make matters even worst, the patient yelled at me with disgust “Where have you been?” I almost snapped, but no, I am a professional with many years of experience, I have encountered worst. I politely, but firmly told that individual that when I am absent I am with some more critical than you. It my sound bad, but it is the prime truth. That patient did not utter another word, and I left and said I would be back as soon as I can

The demand on nurses do not always come form patients or their family members but the doctors too. Some doctors will see how overwhelmed you are, yet still they are yelling and asking why their orders are not yet carried out, or running to the charge RN to make complaints, calling nurses names and using expletives. I believe they think we are robots and ‘superman’. Yet still, we have to fix and re order their incorrect orders, clean up after them, and make excuses to the patients on their behalf The number of times we have gone twelve or thirteen hours without a break is horrendous, full coverage is needed for a break time, and I will never leave a critical patient for a meal. Not every time there will be a relief to cover for an uninterrupted half hour. Some RNs will clock out, and eat at the desk. That is one thing I will never do. I will eat, but I am not clocking out if I am not relieved. The truth is, when I am seeing one patient, the reality is that the others have to wait. There is no way around this. The intelligent thing is to prioritize care. Situations like these, colleagues, and charge RN collaborate in the care of the other patients not attended to if possible. It is better when there is a team approach, to lend support and carry the burden. But it is not always the case. On top of this, every intervention is timed, and management will be emailing you if your times are not adding up. They will ask questions like, why wasn’t your patient discharged in the specified time frame or taken to the floor within thirty minutes. It is very pressuring, and I feel if they do not really understand until they are in our position, or they simply forget, once they become managers. We are constantly reminded to give our all, which we often times do. I wonder if this is the reason some patients may feel as their RN has no other patient, but solely them. I often wonder, in addition to the white board they stress we fill out for each shift. Why not also state that your assigned nurse has three other patients for the shift. I think this would eliminate some misconceptions, and better inform our patients of the management of the ER. It is tough to be a successful RN, and only those called and can endure will survive, I personally would have left the profession, if I never felt it was a calling. The expectations are becoming increasingly ridiculous, and many have fled before they even started.

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