Yes. I have heard of nursing being called a pink collar ghetto. I cannot stand most medial dramas on TV because they ALL have docs doing nursing stuff. ER is one of the worst. I’m not sure Grey’s Anatomy is actually a medical show at all–I think they just dress the cast in scrubs. MASH, St Elsewhere, Marcus Welby, General Hospital, that one show with Jill St John (very old–Emergency?), even my beloved House, NONE of them portray nurses accurately or fairly. I give House a pass due to the divine Hugh Laurie, plus I like the mysteries (it’s not lupus!).
Nurses did manage to stop a stupid nurses show from airing. I don’t recall the name of it, but it was to star Suzanne Pleshette, back in the early 90s.
All that said, nursing suffers from a distinct lack of humor regarding itself. IOW, it takes itself too seriously. Johnson and Johnson (I think) had to withdraw an ad depicting a nurse basically getting off in the shower due to the wonderful body wash or shampoo she was using. So, sometimes I think we’re too stuffy.
Then again (too bad I can see so many sides to things, eh?), what do you think of when you think nurse?
Battleaxe aka Nurse Ratchet (there are still people who think that if you piss off your nurse, she will seek revenge via enema. For the last time: no).
Sexpot–male fantasies have a lot to answer for.
Nurse looking for her husband at work as in Mrs Doctor Nurse. I’ve known a few of these, but not in the past say 8 years.
Frustrated woman kept from furthering her education by chauvinstic dad. This woman is dead or lives in Utah (joke).
Does anyone(layperson) NOT think of white uniform and cap?
Yes. I can see the lack of prestige and high status being a problem. It’s not across the board, but a lot of my peers seem to think it’s a step down for someone with a Bachelor’s degree already. I’ve heard a lot of “well, this is a new direction for you” type remarks. I’ve had people ask me why I’m going to the hospital to change “old men’s diapers” instead of getting a Master’s degree in something or going to med school. I just try to fight ignorance every step of the way. It’s hard. A lot of people my age have the perception that RNs=CNAs. I’m not going to be a nurse’s aide, which takes 6-10 weeks of education…I had to take organic chemistry for this!! For what it’s worth, most people who have been hospitalized for any length of time have a lot of appreciation for what I’m doing.
The hard work–and yes, from all the doctors and all the nurses I’ve known, the average nurse works harder on a daily basis than the average doctor–and the lack of respect for the profession surely create a lot of bitterness. And bitterness can lead to acting out of all kinds.
By the way, eleanorrigby, you’re going to be the RN I shadow for my role transition in December, right? (I’ll probably be assigned to someone by the school, but hey, I can dream, right?)
Yes, yes, yes!! When my husband me what surprised me most about working in a hospital (years ago, when I was in research), I said, “Well, for one, the doctors are NOT the protagonists.”
But I watch House too. And laugh every time the doctors run their own labs.
One day, while chatting with a security guard, my professor showed me the best response to “Hey, where’s your white cap and stockings?”
“Um…you’re dating yourself, do you realize that?” Said with the :dubious: look on your face.
The best thing you can do, once you’re “loose” on the floors to shadow an RN? Go up to her or him. Don’t interrupt them. Smile; introduce yourself. Tell them you’re here until suchandsuch time and that’d you like to work with them today. Volunteer to go get stuff or help with stuff.
I think I can safely speak for all RNs when I say we get impatient with those who hold and hang back. Staying at the station may feel more comfortable, but you’ll learn nothing. This is not really addressed to you,** Frail,** just a general observation. The best preceptees have a plan of action. It may be completely offbase for the situation we’re faced with, but I appreciate a plan–because it shows me you’re thinking. You cannot be passive in nursing and expect to learn or survive.
I like to quiz my preceptors–not to shame them, but to get them to think. Here’s a scenario for you:
You have 4 pts. #1 is stable and most likely will be d/c’ed today, but has a prima donna for a doc. #2 is an unstable diabetic who isn’t eating her breakfast, but noc shift gave her insulin at 0645 and it’s now 0800. #3’s IV pump is beeping–you can hear it from down the hall. #4 is off the floor for an MRI. You are just out of report (it ended late-common occurrence). Three things happen all at once(see below). To which do you attend first?
Dr Prima Donna is on the phone, demanding labs and an ego stroke from you.
CNA reports that #2 seems “groggy”. Trays are being cleared.
Wow. I could almost see someone objecting but didn’t think it would be right away! Suffice to say there was more to it than the details I gave, I just told you the ones pertinent to the story. If you want to debate finer points, you can do it by yourself because I’m not about to get involved in a 10 page thread justifying myself when it’ll just seem like I’m backpedaling the entire time. Though I will say that I didn’t pick someone at random but someone who was retaining greater than 800 mls of urine (Ain’t bladder scanners grand!).
Hm. Hopefully I don’t accidentally reveal I’m crap at my job now! Anyway, the way it would probably go down here is:
Stick my head in the room for 2 seconds and make sure it’s just beeping for an empty IV bag or an IVAB gone through. If the family try to delay me aplogise and say I’ll be back but I’ve got a possible emergency to attend. In my experience even the most assholish and litigious patient/family doesn’t want to think they’re about to be partially responsible for another patient’s death.
Do a blood sugar ASAP. If it’s below 4 (mmol/litre, I think you guys measure it differently?) grab them a can of lemodade and some cookies/toast. If they refuse to eat it call the doc ASAP for an order for some IV glucose to push. Keep doing blood sugars half hourly until they come up. Of course, if the insulin they were given in the am was a long acting one it might not be something to worry about too much – but can’t be too safe!
Dunno about the US (which is clearly not as nice a place to work) but here the doc’d take lowest priority no matter what IF I had the other two situations at the same time. Someone else would answer for me, most likely the charge nurse, and no-one would say no as soon as I mentioned the insulin thing.
All I can say in reply to your posts for the most part is I’m damn glad I don’t work in the US! It sounds crap, despite the much higher pay.
eleanorrigby, you sound like a perfect preceptor. I really enjoy being made to think, staying engaged with the situations. The worst days of clinical for me are the ones where I feel like I came home without learning much. And that usually means that I was treated like I was “in the way” and kept in the dark. We only have one patient per student per day right now, so it can get really boring, and I’m always trying to find more to do. The RNs won’t give us anything extra, so I end up helping the CNAs with miscellaneous stuff. I’m MUCH happier being shamed…um, I mean challenged.
So, as to your quiz, I’m afraid I’m woefully unprepared for it (only two months in, and haven’t worked on prioritizing/delegation AT ALL), but here goes:
The diabetic patient may be having an emergency, and this is the sort of thing that I can’t send in someone else to check on. Sounds like hypoglycemia, maybe risk for insulin shock, and that patient needs my attention first.
The beeping IV…ah, this is tough, because it’s kind of nasty to have to hear that loud beeping every few seconds. But I could send a CNA in to tell me if the bag is empty or if there’s a kink in the tubing, which are the two causes for beeping that I’ve witnessed so far. Both of those can wait for an emergency in the room next door.
Prima donna doctor. Again, tough to put it third, because doctors can and do throw shit-fits about people wasting their precious time. But…it’s totally not urgent. Maybe I can hand those labs off to another RN and have him/her explain that I’m handling a potential emergency, but the patient’s potassium is just fine…that may do the trick.
Be glad that MRI patient isn’t here to cause me SOME kind of grief.
Get a coffee, put it down immediately when the crabby family comes to complain about something else.
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Drink cold coffee.
Tell me if I fail at life and should drop out now.
I must admit that I think of the white uniform and cap — you omitted the cape — but that’s mainly because my mother was a 1940s-vintage nurse (my father was an MD, and no, they did not “meet cute” when she spilled a bedpan on him).
None of your numbered responses fit the image that I’ve developed from observing nurses in action when my daughters were hospitalized (the elder had a congenital jaw problem that required surgery and an overnight stay; the younger developed a major UC flare [we didn’t know she had the condition at all] and was in hospital for a little over two months). I could write a fairly long treatise about what I observed, but for the sake of the collective sanity I’ll boil it down to the following (undoubtedly idealized) summary:The nurse is the patient’s first and last bulwark against the condition that brought him or her to hospital. And sometimes against the medical profession.Apart from surgery or similar procedures, the doctor will see the patient for perhaps 10-15 minutes a day (and sometimes not even that); the nurse is there all the rest of the time, at least in theory (and I know, the reasons that a nurse is not available to answer the call button are legion). The nurse is usually the second person to become aware of a crisis (sometimes the first, if the patient is asleep), whether that crisis is cardiac arrest or a child with a nightmare. And sometimes the nurse has to stand up to his/her nominal superiors and say that a proposed course of action is wrong, wrong, wrong.*
I’m well aware that nurses are human, with a full complement of foibles and shortcomings. I know that some nurses, just like some doctors, policemen, and computer wonks (like me), are jerks. Reading over the posts to date, I realize that we may have been extraordinarily fortunate to have dodged the bullet of these individuals. But as a profession, it’s head and shoulders above at least 90% of human endeavor. I’ve heard it said that when you come down to it, nurses run the medical profession, and just let doctors think they’re the ones in charge; from what I’ve experienced, that’s absolutely true.
(Upon review, I see that what I’ve written doesn’t really address the OP, and thus constitutes something of a hijack. But I’ve spent far too much time and effort on it — part of the reason I don’t post much is that I’m my own worst critic, and I’m constantly revising — to throw it away. So let it stand; perhaps it will contribute to the discussion after all.)
*I got a frantic call one evening from my younger daughter about three weeks after she was admitted. It seems that a floor supervisor had informed her that although she had only received her first round of Remicaid (and thus had two more to go), she was scheduled to be released the next day to finish recuperating at home. Shortly after I got back to the hospital to calm her down, a nurse looked in. Seeing that my daughter was upset, she asked what was the matter, and was told the situation. I’m not sure how to describe it, since nothing changed physically, but I got the definite impression of hackles rising higher than her head. She stormed back to the nurses’ station and started making phone calls, and within fifteen minutes had the release order rescinded.
Ssshhhh! don’t tell them! Someday they’ll clue into it!
RE my quiz.
First priority is the almost certain low blood sugar. This is a pt with a known hx of unstable blood sugar. Nocs should have given her her AM dose with either her tray in front of her of at least watched her drink some juice prior to giving her insulin (or after). Also, (trick question part because every hospital policy varies somewhat)–noc shift should have checked her blood sugar at 0600. Chances are it was low then, and now the insulin has pushed it even farther. In most hospitals here now, we don’t need an order to push D[sub]50[/sub]W IV. If she can drink, great, but I’d take the syringe down the hall with me anyway. Kudos to the nurse from Oz–absolutely you would be checking that BS more frequently AND calling doc to let him know a condition update. I’d alert the aides as well–this pt is now a “feeder” in that she needs to be watched to make sure she eats. (also, the aides do our BS here for the most part)
Second priority is the family and the IV. You will have to deal with this family all day long–best to start out on a good note, if possible. Nothing wrong with apologizing to them as you come in to assess by saying you had an emergency in another room. I’m a big believer in reality checks for families. As much as they love the pt, that pt is not the only pt on the floor–it helps to remind them (nicely) of that sometimes. Good idea on sending an aide to check–heck, even just asking her–she might already know if the bag is dry. Our pumps start a “low level” alarm when the programming reads “empty”–it delivers 5cc/hr while low level alarming. Of course, if the bag is dry, eventually the tubing will empty of fluid… And there is a good chance that it’s something else entirely, like an occlusion. Afterall, it’s not likely that noc shift would leave you a quite that almost empty bag, if you follow me.
Third and last priority is Dr Prima Donna. Couple of reasons: 1. my hospital has a portal available to all the docs who care to use it. He could have gotten those damned labs from the comfort of his own home, cell phone or office computer–or any other station in house. I see no need to hold his hand. However, no reason to antagonize him unnecessarily–so if he stays on hold that long, I’ll say sorry for the delay, but Ms X is doing fine etc. and he’ll have to hold for the labs. Chances are, if he has held on the line that long, he has some important info to share with me. If he hung up, I would assess his pt, get the labs and then page him back.
This is fun, and I can’t sleep. But I won’t hijack this thread anymore. Maybe I’ll put together some scenarios (god, I must be bored) so we can play off one another? Feel free to put your own in… (what forum would it go in–I suppose MPSIMS).
Remember, no actual med advice, and protect pt confidentiality.
I don’t know about nurses, but in general most shift-related jobs give the worst shifts to the newbies. I’ve had the worst shift as a lab tech (fourth shift, weekends and holidays) in two jobs; most of the 24h “guards” at my local hospital go to the Residents and Adjuncts (be they nurses, lab techs or docs). It’s got nothing to do with nurses or with how people pee; it’s got to do with the perks of seniority. One of those perks is “better work hours.”
(I’ll probably be assigned to someone by the school, but hey, I can dream, right?)
