I was about to ‘boost’ a patient up in the bed with a colleague and I noticed how strong she was. I hardly did anything! Later that night, a patient coded and she started CPR. I noticed that she could do it for such a long time with so much force. She’d take a break just for a few minutes before she took over again.
When I took over, I realized how little endurance I had. I was wiped out after a minute.
After the code, another colleague mentioned how she heard pumping noises right before the code was called. She knew that it was that strong nurse doing CPR.
After I went home for the day, I felt my abs hurting.
This made me think about all the strong nurses there are. Especially in the ICU. Especially her. So she’s my strong nurse idol. I want to be a strong nurse.
I bought new running shoes and workout clothes yesterday from Adidas. I haven’t had a sports bra since high school (I’ve been swimming instead). I have to build my endurance. Do free weights. Etc.
According to a patient in the hospital, these are the top 10 things patients should know about nurses. I thought that this did a good job of summarizing what nurses do at the hospital from the patient’s point of view.
1. You have been placed in the hospital for nursing care.
2. The provider of that care is an educated individual who unselfishly dedicates themselves to your health and well-being. And even though you may not like being told what things are good for you and what are not, the nurse telling you does so to give you a chance to redeem your health and well-being.
3. That provider is proud to be a nurse.
4. That nurse does more than you know. She plans your care around your medical condition, emotional state, abilities to do for yourself (sorry, [nurse], I think you said “self care” in your rant), that nurse provides support to you and your family, she/he is the link between you and the doctor, [and] the everything in the facility.
5. That nurse does your bedside care, she knows what medicine you need when, and how to give it. She knows what all the tubes and stuff are and what they are used for and what to look at them for.
6. That nurse can hang an IV or hold your hand and reassure you.
7. That nurse watches over you and reads monitors and knows when [you’re] sleeping and when [you’re] awake and pulls strings to get you that cup of tea at 3 a.m.
8. That nurse is your lifeline, she can call a whole team of professionals together with her calm voice and make them work their [butts] off for your life with the flash of her/his eyes.
9. That nurse will wish you luck and give you all the instructions you need when you leave her competent care even if you were the biggest pain in the ass she ever met.
10. The nurse is why you are in the hospital and why you will go onward, be it home, perpetual care, or the morgue, she will insure that you do so with your dignity and rights intact. Why? Because it is what a nurse does.
This 90 something year old man was repeating, “I want to die” a couple days before. With stage 4 cancer (meaning, it spread from the source location), he should’ve been DNR (Do Not Resuscitate). But since he started to lose his mind (he couldn’t answer the 3 questions: name, location, and time), his family members began to make decisions for him (as a Heath Care Proxy). His family was in such denial that it was time for him to pass away. They believed he didn’t need morphine to ease his pain and should remain in full code in case his heart rhythm converted to v fib or v tach (at this point, you do CPR).
Throughout the night, he kept moaning. But his family would only allow him to take Tylenol. Which honestly isn’t enough if you have overgrown cells invading essential organs. And these organs allow you to breathe and circulate blood throughout your body.
After I had given out my morning meds and taken out a foley, I saw a nurse run. The next thing I heard was “999 on 1 West”. I saw 2 nurses with the crash cart wheel past me heading to a room in the next district over. When I saw them wheel the cart into that room, I knew it was him. The nurse there was already doing CPR compressions and someone else got the ambu bag ready. Though it felt like 5 minutes, about 30 seconds later, 2 critical care PAs, 3 critical care nurses, 2 MDs, respiratory therapist, nurse educator, patient care assistants, and all the nurses on the unit were there. The PAs took over the compressions. The pads were slapped on.
The EKG monitor was still on, so I watched it go in and out of v fib and v tach. Nurses made the call out to the attending and the family to tell them to come in immediately. My nurse manager told me to go the next unit over to get the Line Cart. I learned fast that’s the cart with the equipment to do a central line. Inserting a central line would allow them to bolus (or “quickly give”) fluid directly to his heart to increase blood pressure. Without a properly beating heart, the body won’t have circulating blood.
When I came back, I saw that he was also bleeding out from his rectum and abdomen. Cracked ribs and his tap sites from before may be the cause. Regardless, I primed the normal saline line to attach it to blood that we would give to him.
More epinephrine was needed. More flushes. The nurse educator asked if I knew any of the nurses in the room so she can document everything that’s happening in the room. I gave some names and then let the nurse who was taking care of him take over.
After the defibrillator delivered the shock, I heard that sound. That sound was an asystole sound. A solid beeeeeeeeeep. I looked at the EKG monitor and saw a solid line. He was gone. He got his wish.
This happened in 17 minutes.
If only he had been DNR and was comforted, he would’ve died more peacefully. He wouldn’t have bled, have cracked ribs, have something tied to keep his tongue down in case of intubation. He died suffering from pain and misery. It could’ve been in peace in his sleep.
Family members may feel guilty if they decide to make their loved ones a DNR. They may feel that they aren’t doing the right thing and that they should do everything possible to save them. But in terminal cases, the focus should switch from treatment to comfort. This increases the quality of someone’s end-of-life care.
In my mind, when I die, I would want to die in my sleep. Peacefully. No pain. Just as living is a part of life, death is too. And we should pass with dignity.
If you’re interested in a list of new graduate nursing residencies throughout the USA, you have to check out RNDeer.com.
As you may know, nursing students are having a difficult time finding a new grad position, even though this “nursing shortage” is upon us. RNDeer has complied a list with over 600 hospitals and skilled nursing facilities that have nursing residencies and accept new nursing graduates. It includes the most up-to-date program links, HR phone numbers, and blurbs about the hospitals and other programs.
For me personally, the most frustrating part about finding a position is organizing the list of places you’re interested in, and then meeting those deadlines! Since hospitals are not like schools, they have varying deadlines from month to month, year to year. Then, you have to fill out a similar form asking similar questions for each and every location.
Just as doctors get “Matched” on Match Day every March by applying to several hospitals at the same time, RNDeer also hopes to do same for nurses. They will unveil a common application. So far, they’ve received positive feedback from nursing students and hospitals alike.