Wednesday, June 1, 2011
Night Shift Emergency Room:
Was a couple of busy nights in the ER, family in from out of town but haven't forgotten you, Dear Patient; We will catch up again beginning tomorrow as we move through the corridors, down the hall and out the double doors of the ER into the "Hospital Experience."
Sunday, May 29, 2011
Let's Go Shopping !!!!
Dear Patient; I invite you today to go on a shopping trip with me. No need to bring your wallet, we'll only be shopping for "thought provoking" items. You know, the things that make you go "hmm." items. Pick your favorite place, envision it. Got it? Be sure to look out for those "RED light ER specials" they may just save you at some point in your life, if you end up going "Beyond The ER Doors." Buckle your seat belt, I'll drive.
We've arrived at the destination of your choice; (Remember, your brain may not have chosen to come to the ER but your body demanded it) much like this trip. Your brain may not have wanted to arrive but you needed to "pick something up."
The first thing you may notice is that your store of choice has a "greeter." Someone whose job it is to "welcome" you to your "shopping experience" whether you want to be here or not. Many hospitals now offer that same service. Greeters. Personally, I'm not sure the "greeter" concept is effective or not, or if being "greeted" has truly "enhanced" my shopping experience from entrance to exit. See? I just bought my first hmmm" moment. Are you "hmmming" too?
Shopping cart in hand, we head down the first aisle of your choosing. You are having trouble finding your first item, and so you stop a "sales associate" to ask if they might help you find it and are met with blatant disregard. "I don't know where it is, maybe try aisle 10." and they turn away from you and back to their laughing conversation with their co-worker. You've just met the first person you actually PAY for your shopping experience when you get to the register to check out. Are you walking away feeling a little put off by that first experience? Did you say anything to the sales associate? Most of us probably said a little something, some, maybe more than others; such as or perhaps; "If you don't know where to find it, then could you find out or find someone who does?" and with the look on the sales associates face, you are supposed to feel "sorry" for interrupting much less expecting anything from this person. Did this person lay one hand on you?
And now let's compare our shopping prices; Would you have allowed this same person who could NOT answer your questions, who seemed indifferent to your experience, who looked at you as a "whatever" human being.......would you have allowed them to stick you with a needle? Give you medication, put you in a gown, put oxygen on your face without STOPPING them in their tracks? The answer should be a resounding "no" but so many times, I watch patients compromise THEMSELVES, sacrifice up, per se, their lives, (and yes, it is your life, we start IV's, push medications and do all kinds of things to your body), without so much as a question from you. Did we just put that thought provoking item in our shopping cart?
Moving on you want to try on a pair of jeans. You arrive to the dressing room only to find that the jeans are dirty and the snap is broken on the zipper. Did you slide those jeans on your body regardless? Did you take that soiled, broken pair of jeans out to the person at the desk and say "I'll be taking these."??? Of course not. But you will slide into a hospital gown without even having looked at it to see if it's clean or soiled. (Hospitals are not perfectly running machines Dear Patient, and like ANY other place on this planet, not every single person does their job to 100% on every given day) - understand I'm not slighting or stating this to be fact, rather, it is another "thought provoking" item you might want to recognize and purchase. Is your gown clean? Sheets clean? Stretcher clean? Side rails clean? Do you know how many people are on that stretcher in a given day? The good RN's/Tech's and House-keepers truly make a valiant effort to clean their area's, wipe those stretchers with antiseptic after a patient leaves, prior to putting a clean sheet on. Make sure yours did. Germs..........don't get turned away at the door by the '"greeters."
You are now in the kitchen items; You purchase a few things. A couple of spatula's and a mixing whip. When you get home, will you place those directly in your kitchen drawers? Of course not. GASP. Because you say to yourself "how many others may have touched these and where were their hands prior to touching them?" and so they go directly into the dishwasher. After all, you want to protect yourself and your family from germs and anything else that might make you ill.
Dear patient. Did your RN wash their hands? Use the alcohol dispenser prior to touching you? If they come into your room rubbing their hands together, chances are, the answer is yes. If not - you have the RIGHT to ask them to wash their hands. Do they wear gloves when starting your IV? Those gloves protect us, but they also protect YOU. Is the equipment they use clean? When they are gathering their supplies (this is one of my biggest pet peeves) - and they tear tape to use to tape down YOUR IV, do they place those tape pieces on the stretcher railings? They are going to place that same tape near the now open "wound" they created with a needle, that leads directly, into YOUR bloodstream. Dear Patient; every nurse has their own way of taping down an IV but putting that tape on a stretcher railing should not be part of it.
<Side Bar> OK ALL RN'S TAKE A BREATH; I'm not saying anything you don't know to be fact. I personally, use a sterile (right out of the package) occlusive first, tape to the hub so if the IV works its way loose, I can still tighten it and use tape on top of that to reinforce how secure it is. If I need to tape prior to the occlusive, I will actually give the patient some alcohol rub to clean their hands, and put my torn pieces of tape on the back of the hand I won't be using for their IV. That way, at least I am transferring from the patient, to the patient. Other idea's are welcome welcome welcome. Keep in mind, what I'm talking about here is protecting OUR patient. Thoughts?
Okay Dear Patient; we now have a couple of "thought provoking" items in our cart. You with me? Let's head on up to the register to check out.
As we approach the registers, the lines are long, the wait is long. We start searching frantically for the shortest line, the one that will get us out of here quicker. SOMETIMES they will open a new line to help propel the customers out faster in a more satisfactory manner. Sometimes, you have no choice. You will be waiting in line. You know those things they put up by the registers hoping you might pick one up at the last minute and spend more money? We are going to do just that. We're going to pick up one more last minute, "thought provoking" item.
Dear Patient; We really do try our best to meet your needs in the most efficient professional manner available to us; many times, we can "open another line" by working as a team (staff that are not busy are professional enough to help those staff that are busy) but there are just going to be times that we cannot "open" that additional line. We may be working short. Maybe one or more nurses has called in sick and we have no replacement, which increases the amount of patients the remaining nurses must care for. It increases our stress levels for sure and your waiting times. We are responsible for you and good RN's don't take that responsibility lightly. Just as we should try to meet your needs, please consider that our "hurried" nature may have nothing to do with our "caring" nature. It may have everything to do with how many patients are standing in "our lines."
At this point, Dear Patient, you do always have the choice of "line jumping." We all do that if we feel it will "hurry" us out the door. Doesn't always work does it? And why are we always in such a hurry anyway? You can line jump in our Emergency Department too. Did you know that? If you feel that your ER Doc, RN/Tech are not meeting your needs or have slighted you in any way, you have the RIGHT to line jump and ask to see the "Charge Nurse" and she can assure a smooth "check out" process for you from that point forward.
As we push our cart back to the car, you have already processed in your mind whether or not the shopping experience was a positive or negative experience for you. It will affect your "choice" to return to the same store again.
In your ER experience, it is our job to understand your needs and to address them to the best of our ability. We need, encourage and appreciate your willingness to help us, help you. (Didn't Jerry McGuire say that?)
I think we have sufficiently "filled" our shopping cart today; I hope your experience, was a pleasant one and thank you, for shopping with me and allowing me to drive you along during that ride; Trust; What a powerful, powerful emotion.
Now that we've started your IV - maybe tomorrow we can roll your stretcher out of the ER on a field trip we can call " The hospital experience." Rest up. OH, and be careful with that IV and have you given us that urine sample yet?
We've arrived at the destination of your choice; (Remember, your brain may not have chosen to come to the ER but your body demanded it) much like this trip. Your brain may not have wanted to arrive but you needed to "pick something up."
The first thing you may notice is that your store of choice has a "greeter." Someone whose job it is to "welcome" you to your "shopping experience" whether you want to be here or not. Many hospitals now offer that same service. Greeters. Personally, I'm not sure the "greeter" concept is effective or not, or if being "greeted" has truly "enhanced" my shopping experience from entrance to exit. See? I just bought my first hmmm" moment. Are you "hmmming" too?
Shopping cart in hand, we head down the first aisle of your choosing. You are having trouble finding your first item, and so you stop a "sales associate" to ask if they might help you find it and are met with blatant disregard. "I don't know where it is, maybe try aisle 10." and they turn away from you and back to their laughing conversation with their co-worker. You've just met the first person you actually PAY for your shopping experience when you get to the register to check out. Are you walking away feeling a little put off by that first experience? Did you say anything to the sales associate? Most of us probably said a little something, some, maybe more than others; such as or perhaps; "If you don't know where to find it, then could you find out or find someone who does?" and with the look on the sales associates face, you are supposed to feel "sorry" for interrupting much less expecting anything from this person. Did this person lay one hand on you?
And now let's compare our shopping prices; Would you have allowed this same person who could NOT answer your questions, who seemed indifferent to your experience, who looked at you as a "whatever" human being.......would you have allowed them to stick you with a needle? Give you medication, put you in a gown, put oxygen on your face without STOPPING them in their tracks? The answer should be a resounding "no" but so many times, I watch patients compromise THEMSELVES, sacrifice up, per se, their lives, (and yes, it is your life, we start IV's, push medications and do all kinds of things to your body), without so much as a question from you. Did we just put that thought provoking item in our shopping cart?
Moving on you want to try on a pair of jeans. You arrive to the dressing room only to find that the jeans are dirty and the snap is broken on the zipper. Did you slide those jeans on your body regardless? Did you take that soiled, broken pair of jeans out to the person at the desk and say "I'll be taking these."??? Of course not. But you will slide into a hospital gown without even having looked at it to see if it's clean or soiled. (Hospitals are not perfectly running machines Dear Patient, and like ANY other place on this planet, not every single person does their job to 100% on every given day) - understand I'm not slighting or stating this to be fact, rather, it is another "thought provoking" item you might want to recognize and purchase. Is your gown clean? Sheets clean? Stretcher clean? Side rails clean? Do you know how many people are on that stretcher in a given day? The good RN's/Tech's and House-keepers truly make a valiant effort to clean their area's, wipe those stretchers with antiseptic after a patient leaves, prior to putting a clean sheet on. Make sure yours did. Germs..........don't get turned away at the door by the '"greeters."
You are now in the kitchen items; You purchase a few things. A couple of spatula's and a mixing whip. When you get home, will you place those directly in your kitchen drawers? Of course not. GASP. Because you say to yourself "how many others may have touched these and where were their hands prior to touching them?" and so they go directly into the dishwasher. After all, you want to protect yourself and your family from germs and anything else that might make you ill.
Dear patient. Did your RN wash their hands? Use the alcohol dispenser prior to touching you? If they come into your room rubbing their hands together, chances are, the answer is yes. If not - you have the RIGHT to ask them to wash their hands. Do they wear gloves when starting your IV? Those gloves protect us, but they also protect YOU. Is the equipment they use clean? When they are gathering their supplies (this is one of my biggest pet peeves) - and they tear tape to use to tape down YOUR IV, do they place those tape pieces on the stretcher railings? They are going to place that same tape near the now open "wound" they created with a needle, that leads directly, into YOUR bloodstream. Dear Patient; every nurse has their own way of taping down an IV but putting that tape on a stretcher railing should not be part of it.
<Side Bar> OK ALL RN'S TAKE A BREATH; I'm not saying anything you don't know to be fact. I personally, use a sterile (right out of the package) occlusive first, tape to the hub so if the IV works its way loose, I can still tighten it and use tape on top of that to reinforce how secure it is. If I need to tape prior to the occlusive, I will actually give the patient some alcohol rub to clean their hands, and put my torn pieces of tape on the back of the hand I won't be using for their IV. That way, at least I am transferring from the patient, to the patient. Other idea's are welcome welcome welcome. Keep in mind, what I'm talking about here is protecting OUR patient. Thoughts?
Okay Dear Patient; we now have a couple of "thought provoking" items in our cart. You with me? Let's head on up to the register to check out.
As we approach the registers, the lines are long, the wait is long. We start searching frantically for the shortest line, the one that will get us out of here quicker. SOMETIMES they will open a new line to help propel the customers out faster in a more satisfactory manner. Sometimes, you have no choice. You will be waiting in line. You know those things they put up by the registers hoping you might pick one up at the last minute and spend more money? We are going to do just that. We're going to pick up one more last minute, "thought provoking" item.
Dear Patient; We really do try our best to meet your needs in the most efficient professional manner available to us; many times, we can "open another line" by working as a team (staff that are not busy are professional enough to help those staff that are busy) but there are just going to be times that we cannot "open" that additional line. We may be working short. Maybe one or more nurses has called in sick and we have no replacement, which increases the amount of patients the remaining nurses must care for. It increases our stress levels for sure and your waiting times. We are responsible for you and good RN's don't take that responsibility lightly. Just as we should try to meet your needs, please consider that our "hurried" nature may have nothing to do with our "caring" nature. It may have everything to do with how many patients are standing in "our lines."
At this point, Dear Patient, you do always have the choice of "line jumping." We all do that if we feel it will "hurry" us out the door. Doesn't always work does it? And why are we always in such a hurry anyway? You can line jump in our Emergency Department too. Did you know that? If you feel that your ER Doc, RN/Tech are not meeting your needs or have slighted you in any way, you have the RIGHT to line jump and ask to see the "Charge Nurse" and she can assure a smooth "check out" process for you from that point forward.
As we push our cart back to the car, you have already processed in your mind whether or not the shopping experience was a positive or negative experience for you. It will affect your "choice" to return to the same store again.
In your ER experience, it is our job to understand your needs and to address them to the best of our ability. We need, encourage and appreciate your willingness to help us, help you. (Didn't Jerry McGuire say that?)
I think we have sufficiently "filled" our shopping cart today; I hope your experience, was a pleasant one and thank you, for shopping with me and allowing me to drive you along during that ride; Trust; What a powerful, powerful emotion.
Now that we've started your IV - maybe tomorrow we can roll your stretcher out of the ER on a field trip we can call " The hospital experience." Rest up. OH, and be careful with that IV and have you given us that urine sample yet?
Saturday, May 28, 2011
"I'm Here To Start Your IV"
As you move back into the perception of your own reality; and even though you have been taken on a "heart" field trip around the Emergency Room, it has not nor will it ever, change the perception you have of your own reality.
You've now been in the Emergency Department approximately forty-five minutes. You have seen the ER physician, you have seen the ER registrar, who has taken all of your personal information and health care insurance (or not) information; and now, you are headed toward your treatment phase. Ready?
As the curtain draws back, an RN or ER Tech enters your room as thought they've already been given permission to do anything and everything they need to do as far as your care is concerned. We all do it. It's not intentional. It's a mind-set of not only accomplishing the task we have before us but of getting your results back as quickly as we can so that we can propel you forward in your treatment. Many times, we are as anxious to get your results as you are because it will help us start putting the parts of your "illness" puzzle together in our own minds as we work with our ER Doc.
Remember, you are not our only patient, normally, we have a ratio of one RN to four ER patients. Bear in mind; Our other three patients could be critically ill, and in a moment, our whole world as an ER RN could turn on it's axis, we never, ever, know what will happen from second to second in the Emergency room. Ever. And so while we may have no choice but to be "hurried" we should still be informative, caring and compassionate.
And so, when we pull that curtain back a little bit too briskly and approach you as though we have a 'RIGHT" to YOU ~ it's not meant in an offensive manner. HOWEVER: This is how it will go unless YOU take some control of your "life" situation.
Curtain draws back; An abrupt "Hi, I'm your RN, I'm here to start an IV and draw some blood, we're also going to be getting some Xray's and I will be giving you some medication in the IV and I will be hanging some fluid to hydrate you a little bit. I need some urine. If you do not feel that you can give me a urine sample at this time, I can give you a few minutes but if you can't accomplish this pretty quickly, I may need to put a tiny catheter into your bladder to pull some urine, so that we can get your results back as quickly as possible." Dear Patient, did your brain just say "What?" It should have. Did you manage to get the words from your brain to your mouth? Or are we already tying a tourniquet onto your arm as we wipe the area with an alcohol pad?
Dear patient; This is where you SHOULD and I think any good RN or ER Tech would ENCOURAGE you to say something along the lines of " what is the IV for? Will the blood be drawn from the IV so I don't have to be stuck again for the blood? What kind of tests did the Doctor order, what kind of medication are you going to give me? Why? What's it for, and what will it do for me?"
Maybe this would be a good time to tell the RN or ER Tech which vein you know to be a pretty good vein from having your blood drawn previously or having had an IV before. The RN should heed to you - you know your body better than we do. It's at least worth a look, don't you think? Point it out to us. This is YOUR body;
We will not be able to tell you what the Doc is "looking for" because nurses are not diagnosticians. While most of us have advanced assessment skills and have drawn our own diagnostic "idea's" we are not your ER Doc and we will never assume (or shouldn't) assume that position.
Do not be afraid to tell us if you are in pain. We will talk in great detail about RN's that snort at the thought of giving their patients pain medication or (gasp) being your advocate to assure you DO get the pain medication you need - but for today let me just say, if you are hurting, tell us. We are the bridge to your ER Doc, we have the power to help you with that pain. Ask us. It's time that patients are given back their "rights" in health care. The age of "don't speak" needs to find its end.
Do not be afraid to tell us if you do not want one of the treatments we are here to deliver. A caring devoted, compassionate RN will attempt to encourage you (not intimidate you) into the treatment by explaining why it is beneficial to you. If you still do not want it, we will notify our Doc's and ask them to come talk further with you.
How many times have I said the words "don't be afraid" as we moved to start your IV in today's blog? Has it even entered your consciousness that you should have never been afraid to begin with? You chose to come to this Emergency Department. Your choices do not end when we put a name band on you and you should never be "afraid" of talking with Emergency room staff. Not ever.
Tomorrow let's talk about your last trip to a department store; It's all related; But for now Dear Patient; I'm here, to start your IV.
You've now been in the Emergency Department approximately forty-five minutes. You have seen the ER physician, you have seen the ER registrar, who has taken all of your personal information and health care insurance (or not) information; and now, you are headed toward your treatment phase. Ready?
As the curtain draws back, an RN or ER Tech enters your room as thought they've already been given permission to do anything and everything they need to do as far as your care is concerned. We all do it. It's not intentional. It's a mind-set of not only accomplishing the task we have before us but of getting your results back as quickly as we can so that we can propel you forward in your treatment. Many times, we are as anxious to get your results as you are because it will help us start putting the parts of your "illness" puzzle together in our own minds as we work with our ER Doc.
Remember, you are not our only patient, normally, we have a ratio of one RN to four ER patients. Bear in mind; Our other three patients could be critically ill, and in a moment, our whole world as an ER RN could turn on it's axis, we never, ever, know what will happen from second to second in the Emergency room. Ever. And so while we may have no choice but to be "hurried" we should still be informative, caring and compassionate.
And so, when we pull that curtain back a little bit too briskly and approach you as though we have a 'RIGHT" to YOU ~ it's not meant in an offensive manner. HOWEVER: This is how it will go unless YOU take some control of your "life" situation.
Curtain draws back; An abrupt "Hi, I'm your RN, I'm here to start an IV and draw some blood, we're also going to be getting some Xray's and I will be giving you some medication in the IV and I will be hanging some fluid to hydrate you a little bit. I need some urine. If you do not feel that you can give me a urine sample at this time, I can give you a few minutes but if you can't accomplish this pretty quickly, I may need to put a tiny catheter into your bladder to pull some urine, so that we can get your results back as quickly as possible." Dear Patient, did your brain just say "What?" It should have. Did you manage to get the words from your brain to your mouth? Or are we already tying a tourniquet onto your arm as we wipe the area with an alcohol pad?
Dear patient; This is where you SHOULD and I think any good RN or ER Tech would ENCOURAGE you to say something along the lines of " what is the IV for? Will the blood be drawn from the IV so I don't have to be stuck again for the blood? What kind of tests did the Doctor order, what kind of medication are you going to give me? Why? What's it for, and what will it do for me?"
Maybe this would be a good time to tell the RN or ER Tech which vein you know to be a pretty good vein from having your blood drawn previously or having had an IV before. The RN should heed to you - you know your body better than we do. It's at least worth a look, don't you think? Point it out to us. This is YOUR body;
We will not be able to tell you what the Doc is "looking for" because nurses are not diagnosticians. While most of us have advanced assessment skills and have drawn our own diagnostic "idea's" we are not your ER Doc and we will never assume (or shouldn't) assume that position.
Do not be afraid to tell us if you are in pain. We will talk in great detail about RN's that snort at the thought of giving their patients pain medication or (gasp) being your advocate to assure you DO get the pain medication you need - but for today let me just say, if you are hurting, tell us. We are the bridge to your ER Doc, we have the power to help you with that pain. Ask us. It's time that patients are given back their "rights" in health care. The age of "don't speak" needs to find its end.
Do not be afraid to tell us if you do not want one of the treatments we are here to deliver. A caring devoted, compassionate RN will attempt to encourage you (not intimidate you) into the treatment by explaining why it is beneficial to you. If you still do not want it, we will notify our Doc's and ask them to come talk further with you.
How many times have I said the words "don't be afraid" as we moved to start your IV in today's blog? Has it even entered your consciousness that you should have never been afraid to begin with? You chose to come to this Emergency Department. Your choices do not end when we put a name band on you and you should never be "afraid" of talking with Emergency room staff. Not ever.
Tomorrow let's talk about your last trip to a department store; It's all related; But for now Dear Patient; I'm here, to start your IV.
Thursday, May 26, 2011
Side Bar; When Perception and Reality Don't Matter Anymore; But Being HUMAN Does.....
Dear Patient; Dear Doc, RN, Tech; I'm going to ask each of you to STOP for a moment in each of your propelling perceptions and realities for a moment and come with me to a different place. Another plane; Almost another dimension;
For this moment in time; Let's all join hands and step together into the crash room. Remember that room? Or have you lost yourself already back into your perception and reality? This is exactly why I ask you to walk with me, around the corner, down the hall and as we pull the curtain in the crash room, let's all introduce ourselves to compassion; Let's go from darkness to light; A place we can call on the goodness of all basic human nature; The greatest of these; is love.
As we begin our field trip together; I would stop at the corner of the nurses station here and point for you to notice, a man in his early forties, stretching his two arms as far around three children as he can possibly get them. A young teenage boy, eyes rimmed in red, maybe sixteen, won't make eye contact with staff, eyes shift downward, a nineteenish looking young teen girl, sandwiched between Daddy and brother, no emotion. Frozen, pale, unmoving. Time in her life changing so fast that tomorrow, she will not remember one thing that happened tonight. And standing in the dead center of all of them a boy of approximately six years of age. His eyes, hit you square in the head, he locks in and won't let go. He's too young for distrust, he is simply; scared; What he holds in his tiny body is faith. He believes with all of his heart, that every one of we nurses are the hero's of the world and our Doc's the leader of our hero world.
But there is a panic in this family that has not been addressed; Not because the ER Doc didn't care or the RN's didn't care but because our "caring" had to have a priority; The first of those is to save a life; But this does not negate in the equation that there is a heartache that has not been comforted. Faith that has not been given a drink of water. And we "care" GIVER'S. (Pay close attention to that word medical professionals, it's one we sometimes forget - and it should NEVER be FORGOTTEN.
One moment, this families wife/mother was simply having a headache and some stomach pain. One minute Mom was asking if she could have a Sprite and the next minute, a sea of scrub uniforms converged on her - speaking only to themselves in a foreign language that her family has not a chance to interpret - No permission is asked, no explanation is given. This time, perception and reality have collided into a truth that is called "Emergency." And the ER team is running her to a room where they have access to the equipment they will need to save her life; There is not time to focus on anything but this patient;
But in the ciaos there is one nurse who has managed to break away long enough to glance over her shoulder. The young boy catches her gaze and refuses to let this nurse give up on the stare. The nurse, realizing that Mom is now on life support, surrounded by a loving compassionate professional team; Safe; also realizes instantly that she must put the family on life support as well. The life support of the giving of the human spirit called compassion.
Walking toward the father, she motions he and his children toward a smaller private room. She notices that they move as a unit as she now puts a protective arm around their outer circle. As the nurse has each family member sit down, she drops to her knees so that she is on their level, and not talking above them. She looks at the father first, who finally, looks up, fighting back tears with the pride men typically display. The RN asks if they can ll put their hands together - to find strength in each other's warmth, trembling, humanness; And so they do. The little boy covers the nurses hand with his own, she cannot be sure who else had her hand in the circle but what she was sure of was that God was very present in the room with them.
Slowly, looking each family member in the eyes the nurse says: Please let me tell you a little about what is going on with your beautiful wife and your loving Momma. I know this must be pretty scary, seeing everyone with her all at one time and not understanding why we did that or why we moved her so rapidly - I know you are full of fear and I think I can help you put that fear in a better place. Your wife and Mom was pretty sick when she got here. We were watching her closely. You saw we'd started some IV lines to give her fluid into her body and we'd begun giving her medications to make her feel better; She was fine for a little bit but then her body lost control just a little bit and she needed us to help her gain back that control.
The RN explains that the bigger room while appearing much more "scary" is a room we use so because it is so big that it allows our whole team to be present to help at one time. We know it looks like so much is happening so very fast and it is; but the action we took does not mean that their wife/Momma is going to die. Not today, not in this place.
Before the RN can continue, the father begins to sob aloud. His pride and tension, fear released as he covers his face with his hands and his children follow in union. I too, as that RN, join in allowing my tears to fall to the ground. There are times, that tears must be shed, even by professionals;
Human caring beings. There is no deeper part of humanity than compassion. Empathy, the ability to literally "feel" what it must be like to be in that person or in that person's shoes. Taking the time to feel it all the way through. This "fix" was not a medical. It is not required of an RN but the good ones (and there are many) will let nothing get in their way when it's time to deliver compassionate loving care. RN's that take those emotional chances; feel pain. And Dear Patient, you are so worth it.
Together the RN and this family move as a "unit" back toward the room that just moments ago was frightening and over-whelming but this time appears more as a part of the team that just helped their wife and Momma, get better. They are encouraged to the bedside where yet another RN begins explaining the equipment and even though at this moment their wife and Momma cannot "speak" to them, she can smile and blink and she does; As one loving RN takes over care, another RN exits the room glancing back to see a family together in their "life changing" moment. The father, looks deeply into the RN's eyes and mouths the word "thank you." While those words are so appreciated, they are never necessary; this is what nursing is supposed to be about; Using your knowledge and talent to help save lives. Using your compassion to soothe souls..........that in itself, is a blessing.
And now, back to YOU. Dear Patient, I'm on my way! Has the reality of the field trip, changed your perception?
For this moment in time; Let's all join hands and step together into the crash room. Remember that room? Or have you lost yourself already back into your perception and reality? This is exactly why I ask you to walk with me, around the corner, down the hall and as we pull the curtain in the crash room, let's all introduce ourselves to compassion; Let's go from darkness to light; A place we can call on the goodness of all basic human nature; The greatest of these; is love.
As we begin our field trip together; I would stop at the corner of the nurses station here and point for you to notice, a man in his early forties, stretching his two arms as far around three children as he can possibly get them. A young teenage boy, eyes rimmed in red, maybe sixteen, won't make eye contact with staff, eyes shift downward, a nineteenish looking young teen girl, sandwiched between Daddy and brother, no emotion. Frozen, pale, unmoving. Time in her life changing so fast that tomorrow, she will not remember one thing that happened tonight. And standing in the dead center of all of them a boy of approximately six years of age. His eyes, hit you square in the head, he locks in and won't let go. He's too young for distrust, he is simply; scared; What he holds in his tiny body is faith. He believes with all of his heart, that every one of we nurses are the hero's of the world and our Doc's the leader of our hero world.
But there is a panic in this family that has not been addressed; Not because the ER Doc didn't care or the RN's didn't care but because our "caring" had to have a priority; The first of those is to save a life; But this does not negate in the equation that there is a heartache that has not been comforted. Faith that has not been given a drink of water. And we "care" GIVER'S. (Pay close attention to that word medical professionals, it's one we sometimes forget - and it should NEVER be FORGOTTEN.
One moment, this families wife/mother was simply having a headache and some stomach pain. One minute Mom was asking if she could have a Sprite and the next minute, a sea of scrub uniforms converged on her - speaking only to themselves in a foreign language that her family has not a chance to interpret - No permission is asked, no explanation is given. This time, perception and reality have collided into a truth that is called "Emergency." And the ER team is running her to a room where they have access to the equipment they will need to save her life; There is not time to focus on anything but this patient;
But in the ciaos there is one nurse who has managed to break away long enough to glance over her shoulder. The young boy catches her gaze and refuses to let this nurse give up on the stare. The nurse, realizing that Mom is now on life support, surrounded by a loving compassionate professional team; Safe; also realizes instantly that she must put the family on life support as well. The life support of the giving of the human spirit called compassion.
Walking toward the father, she motions he and his children toward a smaller private room. She notices that they move as a unit as she now puts a protective arm around their outer circle. As the nurse has each family member sit down, she drops to her knees so that she is on their level, and not talking above them. She looks at the father first, who finally, looks up, fighting back tears with the pride men typically display. The RN asks if they can ll put their hands together - to find strength in each other's warmth, trembling, humanness; And so they do. The little boy covers the nurses hand with his own, she cannot be sure who else had her hand in the circle but what she was sure of was that God was very present in the room with them.
Slowly, looking each family member in the eyes the nurse says: Please let me tell you a little about what is going on with your beautiful wife and your loving Momma. I know this must be pretty scary, seeing everyone with her all at one time and not understanding why we did that or why we moved her so rapidly - I know you are full of fear and I think I can help you put that fear in a better place. Your wife and Mom was pretty sick when she got here. We were watching her closely. You saw we'd started some IV lines to give her fluid into her body and we'd begun giving her medications to make her feel better; She was fine for a little bit but then her body lost control just a little bit and she needed us to help her gain back that control.
The RN explains that the bigger room while appearing much more "scary" is a room we use so because it is so big that it allows our whole team to be present to help at one time. We know it looks like so much is happening so very fast and it is; but the action we took does not mean that their wife/Momma is going to die. Not today, not in this place.
Before the RN can continue, the father begins to sob aloud. His pride and tension, fear released as he covers his face with his hands and his children follow in union. I too, as that RN, join in allowing my tears to fall to the ground. There are times, that tears must be shed, even by professionals;
Human caring beings. There is no deeper part of humanity than compassion. Empathy, the ability to literally "feel" what it must be like to be in that person or in that person's shoes. Taking the time to feel it all the way through. This "fix" was not a medical. It is not required of an RN but the good ones (and there are many) will let nothing get in their way when it's time to deliver compassionate loving care. RN's that take those emotional chances; feel pain. And Dear Patient, you are so worth it.
Together the RN and this family move as a "unit" back toward the room that just moments ago was frightening and over-whelming but this time appears more as a part of the team that just helped their wife and Momma, get better. They are encouraged to the bedside where yet another RN begins explaining the equipment and even though at this moment their wife and Momma cannot "speak" to them, she can smile and blink and she does; As one loving RN takes over care, another RN exits the room glancing back to see a family together in their "life changing" moment. The father, looks deeply into the RN's eyes and mouths the word "thank you." While those words are so appreciated, they are never necessary; this is what nursing is supposed to be about; Using your knowledge and talent to help save lives. Using your compassion to soothe souls..........that in itself, is a blessing.
And now, back to YOU. Dear Patient, I'm on my way! Has the reality of the field trip, changed your perception?
Wednesday, May 25, 2011
Perception; Flip Side
Just beyond the ER curtain that makes your room as private as an Emergency room bay can be, your ER Doc has just exited your room; You feel slighted, ignored, unimportant but thus far, have done nothing to utilize what control you can still maintain while in this setting. As you sit analyzing your perception of your experience - this is what is happening beyond your curtain.
Your ER Doc has only taken two steps out of your bay, as he walks, chart in hand, he reaches to the wall to his left, pushing a dispenser that delivers a healthy amount of alcohol to his hands, he puts your chart under one arm, begins rubbing his hands together when three things happen. He notices that one of his patients from bay #28 is being rushed from their original room/bay to what in ER terms, is called the "crash room or trauma bay" pick your favorite, both are pretty scary terms.
He begins to quicken his step heading toward the nurses pushing his patient when he is intercepted by another RN who says "our patient in bay 16 is losing his blood pressure, do you want me to hang dopamine?" to which your ER Doc says "who??" the RN now matches his stride as she begins to pull his attention more toward her patient. As they round the corner, the ER Doc is watching out of one of his eyes as numerous nurses swarm the patient now in the crash room. He asks the nurse now running beside him "what's the pressure?" to which she replies "50/28." Start some Dopamine 5mcg/min/kg and I'll be right there, watch the urine output and pressure. And before your ER physician can quite make it to the crash room, another nurse grabs him by the arm and is saying "I need you in here, I have an allergic reaction." to which your ER Doc says, "check allergies, follow protocol." and he disappears, FINALLY into the crash room where skilled ER RN's are well into ACLS (Advanced Cardiac Life Support) techniques and medications as they work along side the ER Tech's, Respiratory therapist's and X-ray Tech's.
Your ER Doc is focused and on the spot with his assessment and within moments he has intubated, assessed and continued stabilizing treatment on a patient that came in healthy but has had a "change" in their LIFE situation. When your ER Doc feels confident that he can now leave the crash room, he stops off to check on the patient with having the allergic reaction, speaks briefly to them and to their RN and continues down, around and across the ER to check on his patient whose blood pressure bottomed out. Now assured that the staff has his back, his patients stable for this moment; he removes YOUR chart from underneath his arm.
Yes, astonishingly, he HAS not LOST you. You are right there with him. With out time to draw a breath, he re-reads your chart, re-reading his notes, thinking, pondering, assessing and he begins to enter his OWN lab requests, and any other tests he wants to be done on you. YES, he's entering his own orders on the computer. Because in almost every hospital around the United States, ER Doc's no longer can rely on the Unit secretary (I call them command central) to enter his orders, this task has been laid on his shoulders.
Officially, you are one of this ER Doc's 10 patients for this second. When another patient enters the ER, they could become his 11th patient. And if that's not pressure enough, with Obama Care capping costs, Doctors are having to see more people, getting paid less and must keep up a quota (on which they are normally evaluated) to keep their jobs.
And you thought waiting times were bad when you went to see your family physician? At least their appointments are scheduled and they know what kind of patients they're seeing each day during those appointments.
When you come to the Emergency department, you are going to leave with a diagnosis. You are going to have the results of all your xrays and labs, and studies and you will have medication either on board or a script to get them. Where ELSE but an ER do you get care like that? And yet you expect it FAST, KIND, SMILING, ARTICULATE......are you kidding? We strive....but this is an emergency department. Where we see the unexpected, we never know what is coming through our doors, we cannot limit the amount of patients we see each twelve hour shift. (By the way, we eat at our nursing stations because we rarely have time to eat lunch, drink water and or pee ourselves) - Remember perception???
Are you important to this ER Doc? You bet you are; Every single day, he puts it on the line to care for you; His perceptive is probably that he is doing the best he can, given his circumstances and I would place my bet, on the ER Doc - that if you had just trusted enough to speak your truth to him "I'm scared, I'm frustrated, please don't leave yet, could you repeat that" - that if he was to do the right thing, he would have hesitated long enough to listen to your concerns.
Perception for you; You don't matter. Perception for him: You matter so much he'll kill himself trying to get you seen. Reality? You and he needed better communication.
At the end of the day, Dear patient, we are all human beings and we are here to care about you; We want your trust and you deserve our respect and sometimes, we're just as scared as you..............
Dear patient; This isn't the end of your visit.
Your ER Doc has only taken two steps out of your bay, as he walks, chart in hand, he reaches to the wall to his left, pushing a dispenser that delivers a healthy amount of alcohol to his hands, he puts your chart under one arm, begins rubbing his hands together when three things happen. He notices that one of his patients from bay #28 is being rushed from their original room/bay to what in ER terms, is called the "crash room or trauma bay" pick your favorite, both are pretty scary terms.
He begins to quicken his step heading toward the nurses pushing his patient when he is intercepted by another RN who says "our patient in bay 16 is losing his blood pressure, do you want me to hang dopamine?" to which your ER Doc says "who??" the RN now matches his stride as she begins to pull his attention more toward her patient. As they round the corner, the ER Doc is watching out of one of his eyes as numerous nurses swarm the patient now in the crash room. He asks the nurse now running beside him "what's the pressure?" to which she replies "50/28." Start some Dopamine 5mcg/min/kg and I'll be right there, watch the urine output and pressure. And before your ER physician can quite make it to the crash room, another nurse grabs him by the arm and is saying "I need you in here, I have an allergic reaction." to which your ER Doc says, "check allergies, follow protocol." and he disappears, FINALLY into the crash room where skilled ER RN's are well into ACLS (Advanced Cardiac Life Support) techniques and medications as they work along side the ER Tech's, Respiratory therapist's and X-ray Tech's.
Your ER Doc is focused and on the spot with his assessment and within moments he has intubated, assessed and continued stabilizing treatment on a patient that came in healthy but has had a "change" in their LIFE situation. When your ER Doc feels confident that he can now leave the crash room, he stops off to check on the patient with having the allergic reaction, speaks briefly to them and to their RN and continues down, around and across the ER to check on his patient whose blood pressure bottomed out. Now assured that the staff has his back, his patients stable for this moment; he removes YOUR chart from underneath his arm.
Yes, astonishingly, he HAS not LOST you. You are right there with him. With out time to draw a breath, he re-reads your chart, re-reading his notes, thinking, pondering, assessing and he begins to enter his OWN lab requests, and any other tests he wants to be done on you. YES, he's entering his own orders on the computer. Because in almost every hospital around the United States, ER Doc's no longer can rely on the Unit secretary (I call them command central) to enter his orders, this task has been laid on his shoulders.
Officially, you are one of this ER Doc's 10 patients for this second. When another patient enters the ER, they could become his 11th patient. And if that's not pressure enough, with Obama Care capping costs, Doctors are having to see more people, getting paid less and must keep up a quota (on which they are normally evaluated) to keep their jobs.
And you thought waiting times were bad when you went to see your family physician? At least their appointments are scheduled and they know what kind of patients they're seeing each day during those appointments.
When you come to the Emergency department, you are going to leave with a diagnosis. You are going to have the results of all your xrays and labs, and studies and you will have medication either on board or a script to get them. Where ELSE but an ER do you get care like that? And yet you expect it FAST, KIND, SMILING, ARTICULATE......are you kidding? We strive....but this is an emergency department. Where we see the unexpected, we never know what is coming through our doors, we cannot limit the amount of patients we see each twelve hour shift. (By the way, we eat at our nursing stations because we rarely have time to eat lunch, drink water and or pee ourselves) - Remember perception???
Are you important to this ER Doc? You bet you are; Every single day, he puts it on the line to care for you; His perceptive is probably that he is doing the best he can, given his circumstances and I would place my bet, on the ER Doc - that if you had just trusted enough to speak your truth to him "I'm scared, I'm frustrated, please don't leave yet, could you repeat that" - that if he was to do the right thing, he would have hesitated long enough to listen to your concerns.
Perception for you; You don't matter. Perception for him: You matter so much he'll kill himself trying to get you seen. Reality? You and he needed better communication.
At the end of the day, Dear patient, we are all human beings and we are here to care about you; We want your trust and you deserve our respect and sometimes, we're just as scared as you..............
Dear patient; This isn't the end of your visit.
Tuesday, May 24, 2011
Pulling The Curtain Back
I think I've left you sitting on that stretcher in your hospital gown and that thin little white sheet long enough. Not only has your patience visited your brain, it's visited and over-stayed it's welcome. It's gone. Your husband/wife/daughter/son/friend, are also now as anxious as you are because your response to this situation has now become unpredictable. Or perhaps, maybe you're more anxious because you don't know how their resentment will affect your continued ER visit. Fear. As if being in the ER wasn't enough to invoke all the fear you needed for the rest of your day or even week, year. And no matter how the person who is about to open that curtain tries, it's going to be their fault. Perception and reality - our kissing cousins.........remember them?
Because I am a patient advocate - I'm going to start with your perception; While I do believe that perception always has realities back then it's safe to say that I believe no matter what, SOME part of your perception is going to be reality based.
Finally after what seems to have been hours to you, (perception or reality?) the curtain is ripped open and an Emergency room Doc hustles in without any acknowledgement of the family you may have at your bedside. His introduction is so rapid that you're not even sure what his name is; His eye contact may or may not be present; (Did he pull the curtain behind him?") (Does he seem to be rubbing alcohol rub into his hands to indicate to you that he's cleaning his hands prior to touching you) His introduction is followed in rapid succession by a series of questions that you barely have time to answer, much less think about; "What's going on with you today?" "How long has this been going on?" "Do you have any medical history?" "Take any medications?" "Allergies to medication or food?" "Describe the pain to me." And depending on your complaint, he will do an assessment which could include, again depending on your complaint - of feeling an extremity if you've "injured" something" pulling your gown up or back or both, (were you asked if you were okay with that or did you just allow a complete stranger to, in mugging terms, roll you over without your so much as blinking an eye). He may look in your eyes, ears, nose, throat, feeling on your abdomen" he may ask when you last ate, and then the personal onslaught begins. Questions you don't even want to answer in the privacy of your own home and somehow this stranger wants you to answer him in a voice loud enough to be heard across the ER room. "When did you last pee?" "When was your last BM?" "Last menstrual period?" "Could you be pregnant?" And for you men patients, the onslaughter can be exactly the same and just as personal, don't kid yourselves.
And then; without so much as asking if you will be okay with anything he's about to say, he says; "We'll figure out what's going on, we're going to be running some tests. They'll get your blood, we need you to pee, I'm going to do an X-ray (or not) and we'll give you some medication (or not)." and with that, the curtain moves like a wave in motion - as he breezes quickly out of your room." It happened so rapidly that you turn to whomever has come to the Emergency Department with you and say "what did he just say?" Perception or reality? They're kissing cousins; We medical professionals in the Emergency Department know it and you will need to know it, understand it, relate to it, empower yourself to it. You have just allowed yourself to be shut off from YOUR own HEALTH care.
Oh yeah, remember how frustrated and angry you were BEFORE the ER Doc walked in? Did you do one thing constructive with that frustration? I'm guessing no. Why not? Dear Patient, this is just the beginning ...........the curtain, depending on whether your ER Doc opened or closed it behind him, is about to begin blowing in the wind..........again.
Tomorrow; His Reality. What your perception could never begin to interpret. And yes, it makes a difference; For you both.
Because I am a patient advocate - I'm going to start with your perception; While I do believe that perception always has realities back then it's safe to say that I believe no matter what, SOME part of your perception is going to be reality based.
Finally after what seems to have been hours to you, (perception or reality?) the curtain is ripped open and an Emergency room Doc hustles in without any acknowledgement of the family you may have at your bedside. His introduction is so rapid that you're not even sure what his name is; His eye contact may or may not be present; (Did he pull the curtain behind him?") (Does he seem to be rubbing alcohol rub into his hands to indicate to you that he's cleaning his hands prior to touching you) His introduction is followed in rapid succession by a series of questions that you barely have time to answer, much less think about; "What's going on with you today?" "How long has this been going on?" "Do you have any medical history?" "Take any medications?" "Allergies to medication or food?" "Describe the pain to me." And depending on your complaint, he will do an assessment which could include, again depending on your complaint - of feeling an extremity if you've "injured" something" pulling your gown up or back or both, (were you asked if you were okay with that or did you just allow a complete stranger to, in mugging terms, roll you over without your so much as blinking an eye). He may look in your eyes, ears, nose, throat, feeling on your abdomen" he may ask when you last ate, and then the personal onslaught begins. Questions you don't even want to answer in the privacy of your own home and somehow this stranger wants you to answer him in a voice loud enough to be heard across the ER room. "When did you last pee?" "When was your last BM?" "Last menstrual period?" "Could you be pregnant?" And for you men patients, the onslaughter can be exactly the same and just as personal, don't kid yourselves.
And then; without so much as asking if you will be okay with anything he's about to say, he says; "We'll figure out what's going on, we're going to be running some tests. They'll get your blood, we need you to pee, I'm going to do an X-ray (or not) and we'll give you some medication (or not)." and with that, the curtain moves like a wave in motion - as he breezes quickly out of your room." It happened so rapidly that you turn to whomever has come to the Emergency Department with you and say "what did he just say?" Perception or reality? They're kissing cousins; We medical professionals in the Emergency Department know it and you will need to know it, understand it, relate to it, empower yourself to it. You have just allowed yourself to be shut off from YOUR own HEALTH care.
Oh yeah, remember how frustrated and angry you were BEFORE the ER Doc walked in? Did you do one thing constructive with that frustration? I'm guessing no. Why not? Dear Patient, this is just the beginning ...........the curtain, depending on whether your ER Doc opened or closed it behind him, is about to begin blowing in the wind..........again.
Tomorrow; His Reality. What your perception could never begin to interpret. And yes, it makes a difference; For you both.
Monday, May 23, 2011
Perception Having Reality's Back
You've been sitting on that stretcher for an extended amount of time waiting to see where this "life" experience is going to take you haven't you? How's your hiney feeling? A little numb? Frustration level up? Anticipation causing your eyebrows to raise up into your hair line, been peeking out that curtain for Casper? How many times have you said to your husband, daughter/son/friend/wife - "GO FIND MY NURSE!"?? Chances are human nature has prevented anyone from doing much more than the aforementioned. "Peeking" out that curtain. Why is that? Why do you feel you have no rights during this ER experience? What is the worse thing that you have imagined in your mind, that might happen if you "made some waves?" - what holds you back from taking BACK what little control you have over your health care? What drives that fear of ownership in your own life?
Before I go any further, I must, to protect myself; Place some kind of disclaimer at the beginning of each of my blogs. Forgive the redundancy but it's the only way to protect myself while trying to offer you some truths, feelings, tenderness and some emotions.
First and foremost, the experiences that I post will have been changed to protect in every way all resemblance of any patient I or anyone I know, may have cared for in the past. The experience I draw from, to blog with you are my perception of real experiences however, the patients and their descriptions will be generalized and non-specific. Experiences expressed could come from my vast experience in many different hospitals all over the United States. It certainly does not mean that is happened to me yesterday, a week ago or a year ago - my experiences come from having been a medical professional in Emergency rooms since 1981. That covers a lot of ground. My experiences are my own and I have a right to share my "perception" of those experiences as long as I do not compromise the privacy of any said patient or any said hospital. I hope this disclaimer is enough, honestly, I don't know what else I could say to exclaim that this is a blog born of love for my profession, my patients and my belief in being a patient advocate. An advocate for you, or perhaps for someone you love. It's pretty simple really. I'm here; for you.
My disclaimer tomorrow will be obviously shorter but I needed to get it said.
Fear; Your curtain opens in the next blog. Where we will confront your fear of opening the curtain yourself and of the Doc, RN or Tech who may be standing there when you do. What drives your fear to empower yourself in your own health care????? Input?
Before I go any further, I must, to protect myself; Place some kind of disclaimer at the beginning of each of my blogs. Forgive the redundancy but it's the only way to protect myself while trying to offer you some truths, feelings, tenderness and some emotions.
First and foremost, the experiences that I post will have been changed to protect in every way all resemblance of any patient I or anyone I know, may have cared for in the past. The experience I draw from, to blog with you are my perception of real experiences however, the patients and their descriptions will be generalized and non-specific. Experiences expressed could come from my vast experience in many different hospitals all over the United States. It certainly does not mean that is happened to me yesterday, a week ago or a year ago - my experiences come from having been a medical professional in Emergency rooms since 1981. That covers a lot of ground. My experiences are my own and I have a right to share my "perception" of those experiences as long as I do not compromise the privacy of any said patient or any said hospital. I hope this disclaimer is enough, honestly, I don't know what else I could say to exclaim that this is a blog born of love for my profession, my patients and my belief in being a patient advocate. An advocate for you, or perhaps for someone you love. It's pretty simple really. I'm here; for you.
My disclaimer tomorrow will be obviously shorter but I needed to get it said.
Fear; Your curtain opens in the next blog. Where we will confront your fear of opening the curtain yourself and of the Doc, RN or Tech who may be standing there when you do. What drives your fear to empower yourself in your own health care????? Input?
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