Sunday, April 21, 2013

please don't babysit me.

This is a rant. A big RANT. 

My boss came up behind me at work, behind the nurse's station, tapped me on the shoulder, and told me not to look at anything on the internet. For the record, I was reading a foster care blog. Also for the record, all of my patient care was done, my patients were both content, and none of my co-workers needed my help. This was the only time I had sat down from 0800 until 1400. 

So instead, I sat at the desk and did nothing. Then I mosied over and sat around with other nurses shooting the breeze. One nurse flipped through a magazine. So chit-chatting and magazines are ok when you have down-time, but reading online is not? If I had printed the article and read it from paper, she would have said nothing. What is it about the computer that makes older adults think you're playing? Or management, for that matter. It's like you're playing a nintendo or XBox game, but in reality, you're just reading. It's not practical to think that I will be busy every second of every day. Nor is she, I would be willing to bet. It's because of my commitment to patient care that I spend my "downtime" at the desk. I want to be available to my patient's and my co-workers should they need me.

The feeling of being babysat at work enrages me. Reading is not an inappropriate thing to do at work. My work is always caught up, always current, and I'm always ready at the drop of a hat to help someone out. Being treated like a 10-year-old is quite demoralizing. In 10 years, or maybe 20, I hope that this particular brand of management retires out, and a new group that sees the computer not as a plaything or toy, but simply as another medium for information and material, takes their place. I hope they are replaced by my own generation, people who recognize that we have the ability to multi-task and to organize our day in such a way that we get downtime while still getting our assignments done in a timely manner. 

Bottom line, I'm totally capable of reading whilst I wait for the next task that needs to be done. Staring blankly into space or chatting about the latest gossip with co-workers is NOT productive nor does it lead to an informed mind. 

Sunday, April 14, 2013

the end of an era

Care plans are all the rage in nursing. At least they were. In nursing school you are forced to slave over them, re-formatting them to fit your instructor's version precisely. Like almost every other student, I thought they were ridiculous then, and like every other nurse I've ever met since, I think they're ridiculous now.
The premise was a good one. We needed interventions with measurable outcomes (NIC and NOC), and we needed them so that we could "prove" ourselves as a profession, the way that physicians do. From there things got a little crazy. To the point where we, as nurses, had to spend hours listing "interventions", every possible common sense thing you can think of, and daily rating on a scale of 1 to 5 if it was working. If you are a nurse, or even a college graduate of any kind, you should have the ability to recognize a problem, intervene in some way (even if it's just to keep observing), and evaluate internally whether this plan is working or not. You shouldn't have to write 10 paragraphs about it. You shouldn't have to check over 75 boxes per problem! 

To make matters worse, no one was reading these care plans, no one but the poor nurse doing them. They were irrelevant, in the end, to the patient's treatment and plan. It made me feel like a ninny. Like a L-O-S-E-R trying to be important when really that time filling in check boxes and numbers was a total waste. Just busy work. Which made me feel that my real job, that of patient care, that of actual critical thinking, was trivial and menial.

But then... everything changed. They took our care plans away!!!

Yes, care plans, at my current institutional, are a think of the past! I went home and danced naked with bells on my ankles, burning piles and piles of worthless paper, in pure joy! (Ok not really, but I thought about it.) Instead, we have a simple patient/family goal-oriented note, in which we state the patient and/or family members' goals for the shift, and for the hospitalization, and any progress that has been made toward them.

All I have to say is: Good riddance to good rubbish.

Thursday, April 4, 2013

honoring death

I took care of him for 18 shifts. I had a few days of this month, but only a few. So I took this patient, and I kept getting him back. He was on a one-way train to comfort care, and I was there for the ups and downs of it all. The family planned to withdraw on Ned*, my patient, on a Wednesday. That was one of my very few days off... but I came in and worked anyway. I guess I felt like I needed to be there. I was honored that the family wanted me there, but it was more than that. I wanted to make absolutely sure that his death was given priority. That he would not suffer. That his family would have everything they needed.

I didn't know Ned, not in life. I knew him as a premonition of death. Eyes sunken into a skeleton face. Ascites and yellow-tinted skin. That gulping motion that accompanied each breath, even on a vent. All he would say to me was that he couldn't breathe. That he was in pain. That he knew he was in the hospital. During one particularly lively day he mouthed very clearly, "get me the hell out of here". I gathered from his family that he was a stubborn, cantankerous man but very loyal, inspiring fierce devotion from his close friends and family, and more than a few tears at his demise.

But I wasn't there to know about Ned's life. I wasn't there to honor it, either. That was his family's job. I was there to ease his way into death, just as 67* years ago some nurse or midwife or pair of doctor's hands eased his way into life. Just as they did not need to know the details of his life-to-be, I did not need to know the life he had. I was, in that moment, mother and sister and daughter to him, whoever he had been, wherever he was going. I was there to honor his death.

I was there to withdraw on him, and there for his last moments of consciousness. His heart continued to beat (as many stubborn hearts do) long past my shift. I placed my hand in his before I left, and said, "Godspeed Ned." Off you go, out of this world and into the mystery of the Great Beyond. The place we will all eventually find, the place my daughter already knows.

Godspeed, and it was my honor to be your pair of hands on your way out of this great human existence.

*not his real name or age