You don’t care.

Next month Australians will be sent a voluntary postal ballot to vote on whether or not the law should be changed to allow same-sex couples to marry.
This plebiscite is non-binding. If the majority of Australians vote yes, the government has committed to then allowing a private members bill to go before Parliament to decide the issue.
It is estimated the total cost of this process will be around 122 million dollars.

 

Here is poem that Nurse L wrote about Marriage equality from the perspective of a nurse who happens to be a lesbian…

Continue reading “You don’t care.”

Betty’s Death. 

Some time ago  we had a 98 yo lady (whom I will call Betty), transferred to our emergency department from a local nursing home. Betty was having palliative care at the nursing home and was well aware that she was soon going to die. 
Betty had completed an advance care directive (ACD) stating her wishes not to be resuscitated and that she did not wish to die in a hospital, but in her current environment.

She also stated that she would very much like to be able to listen to some Scottish music and in particular ‘Danny Boy’ at the time of her death.
Betty had awoken at 1am with frequent haemoptysis and severe abdominal pain, and despite her wishes and the ACD, the staff at the nursing home decided to call an ambulance.
I don’t know why this happened. Perhaps there was a mix-up with her directives, perhaps there were new staff on who did not know her plan, perhaps they did not feel confident managing her haemoptysis, perhaps they rang her doctor who told them to transport her.

Perhaps it was a combination of things. I don’t want to be judgmental, but I will say that it is my experience that this sort of thing happens far more than it should.

On arrival in our department Betty remained quite alert, and stated to our nurses that she knew she was about to die.

Following a conversation between Betty and our senior doctor, she was given some sedation and analgesia and our nurses made her as comfortable as they possibly could within the context of a busy, noisy, crazy, crowded, abrasive Friday night in the ED.

Oh….and something else happened that night amidst the crazy.

Something so simple and so wonderful, that it made the hairs stand on the back of my neck.

Two of our nurses had noted Betty’s request in her advance care directive.

One of them pulled out their iPhone, they down-loaded Danny Boy…. and then they played it to her as she died.
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This is it! Don’t get scared now.

The following is a guest post by Vanessa Katsoolis.


 

If I ever come across a nursing student in their final year of their Degree that is willing to be honest about how they feel the first thing they will say is that they feel they don’t know enough, that they are scared that they are going to graduate, get their scrubs, put them on and walk into their first day on the floor and not actually know what to do next.

Continue reading “This is it! Don’t get scared now.”

Care goes in. Crap goes out. 

Susan Silk is a clinical psychologist who is also a breast cancer survivor. In a story for the Los Angeles Times, her friend Barry Goldman recounts the day a friend wanted (needed) to visit her immediately following surgery:

Susan didn’t feel like having visitors, and she said so. Her colleague’s response? “This isn’t just about you.”
“It’s not?” Susan wondered. “My breast cancer is not about me? It’s about you?”

Continue reading “Care goes in. Crap goes out. “

A well oiled machine.

The following story is a guest post from Nurse Ruth.

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In the midst of the chaos someone calls to me “Ruth, slow down”.

I am kneeling on the edge of his bed, leaning over his body, with the palm of my hand pressed against his chest. His lifeless body flails as I push hard on his sternum. I am surrounded by a united force of professionals with a solitary goal: to restore his life.

This is tiring work. I have no breath to count out loud. I am listening as orders and requests are made, but I am focussed to the sound of just one voice. The one that keeps saying “charging…clear”!

I quickly relinquish my precarious position on the edge of the bed and lean back against the wall. My legs are shaking and my heart is racing, perhaps faster than his! An electric shock is effortlessly delivered to his quivering heart.

We wait. “No output, resume compressions”!
My break is over. I climb back on the bed and position my hand over the reddened area on his chest and push some more.
My I.D. badge bounces rhythmically against my body with every compression. It is annoying me and I am quickly getting tired. I feel the hand of my colleague on my back; it is her turn to take my place compressing his heart.

Minutes had passed like hours, and the time we started work is now yesterday.
He had been fine just 20 minutes ago when we joked about his snoring. Then our attention is called to the 4 corners of the ward.
I am supporting my patient who is sitting on the toilet simultaneously vomiting and defecating. Another nurse is administering an I.V. antibiotic.
Another is checking her patients’ vital observations.

The tone of your voice alerts me to the urgency of the situation you have just encountered. I instinctively grab some gloves from the dispenser on the wall. The alarm sounds and within minutes a dozen doctors and nurses are at his side. His lips are blue, and now the minutes pass like seconds. You are pounding on his chest and somehow briefing the incoming doctors of the preceding events.
This adrenal rush is better than coffee at the end of our ten-hour nightshift.

All other tasks are now deemed a low priority as we focus solely on him. Theories are considered whilst drugs are given.
His lifeless body is punctured with needles as blood sample are taken.
Again “Charging….clear”! “There’s a rhythm…it’s A.F.” “He’s got output”.

We step back and survey the situation. Who are all these people? They are the right people, in the right place, at the right time. They are all part of the well-oiled machine.

It is the end of our long night shift and we are looking a little battle weary. We have restored his heartbeat, but what about the rest of his body. What about the rest of his life. Someone has made the dreaded phone call to his wife to inform her of the ongoing crisis. This will not be a good day for her.

As nurses we learn to draw a line between the people we “care for” professionally and those we “care about and love” personally. It is time for us to make that distinction as we walk away from an extraordinary shift.
As I leave I ask a senior doctor what will happen next. The simple reply is “C.T. and I.C.U.”

 

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Emergency Department Rules!

A list of essential rules for the ED nurse. Slightly modified from the original Red’s Rules by Ed Hunt.

Bringing a crash cart into the room can ward off evil spirits.

Don’t panic. If the airway is patent, and there is output, get help and then get a set of vitals. It’s useful information and buys you time to figure out your next move. Moreover, it makes you look like you know what you are doing.

Know basic life support like you know your wardrobe. That way the very worst thing that can happen to your patient is comfortable and familiar territory. Moreover you DO know what your are doing.

We will treat all our patients, not just the nice ones.

The patient is not the enemy.

There are many reason for people to be assholes – demanding, agitated, argumentitive. Sometimes it is an underlying disorder of the personality that you have no control over. Sometimes it is because they are dying. Often they don’t know what to expect and aren’t used to being powerless. At the very least, it may be because you just met them on the worst day of their life. This is a good possibility given that they are in an emergency department.

Your job is to try and be the best part of the worst day of their life.

The Emergency Department is an easy place for a nurse to kill people. If you don’t walk into work a little scared of doing so, you probably aren’t paying attention.

Err on the side of the patient. Over time, it is always easier if you do the right thing in the first place. That said, it is never too late to do the right thing.

Support your colleagues at every opportunity. Seek support PRN. This is the vital sign of a strong unit.

You are never the most important person in the patient’s room.

Attend to patients in the waiting room. Review them and inform them.
Let them wait… but don’t let them simmer.

The one time you don’t do what you always do, you will get burned.

Check blood sugar on anyone with altered LOC.

Don’t forget to check for cannulas in dressed patients about to discharge.

Don’t argue with drunks.

Mental health (Psych) is just a label. Nurse the person.

The correct response is ALWAYS “how can I help you?”  They are ALL your patients.

Nurses don’t work for doctors, they work for patients.