In the year and a half I worked in that department, I learned more about medicine, human rights, patients’ responses to loss, and the ambivalent relationships of medical personnel than throughout my entire medical work history and career as a nurse.

Although I later moved on to direct care positions in multiple departments (OB and surgery, Mother/Baby/PP, Med-Surg, Trauma), the emergency room experience was my formal introduction to many foundational aspects of the medical environment, especially regarding the unaddressed conflict in the relationships between the differing roles of providers in medicine.

The main concerning dynamic I observed was that nurses were generally dismissed and disregarded by many physicians, as both professionals and as necessary components in the practise of medicine.

In my experience as a professional, this aspect has still not changed over time and spans throughout all specialties in medicine.

When I became a nurse in the year 2000, I was no longer just the observer of adverse or lack of communication toward nurses from physicians or the frequent poor treatment of physicians toward nurses. I became the receiver of both.

Nursing Expertise Is Still Mostly Misunderstood

Many physicians do not see the nursing staff as an imperative extension of their own care and knowledge. Many are unaware of what most nurses do and how much they know. They do, in fact, just expect their orders to be carried out and quite often neglect to understand the gap that nurses must close from orders of care to implementation of care and then to continued follow-up of care. The latter two skills are what create and sustain patient health and wellness.

Nursing responsibilities, experience and skills remain a neglected and misunderstood facet of healthcare. Most lay people see nurses as the medical personnel carrying out their doctor’s orders, making the necessary calls to patients and hopefully, effectively understanding the medical reasoning and intricacies behind the care and information they are delivering.

However, true nursing goes beyond this.

Learning to regurgitate orders and instructions is not what gets a good nurse through school or what keeps his/her patients alive. Critical thinking, research, and observation while responding appropriately in and to emergent, acute, and chronic situations, listening when no one thinks we are listening, and knowing when the wrong medicine or treatment has been ordered or recommended are.

The doctor will not go to jail if the nurse gives an inaccurately ordered medication, resulting in an adverse event or fatality; it is the nurse.

We are, first and foremost, the buffer between a physician and his patient.

And both patients and physicians need this.

What Effective Nursing Offers To Physicians’ Care of Their Patients

Good nurses listen to their patients and have a knack, not just the training for, for excellent triage. Body language tells more than a patient’s report. Patients’ verbal reports must be delicately and discreetly screened for hidden information that is critical in many cases, to appropriate safe care and orders. Nurses hone in on things not said, or that are mis/underrepresented, which often results in a totally different approach to treatment than at first written.

Nurses’ bedside experience yields a wealth of information and patient history that frequently change the initially documented needs and treatment of the patient’s condition. The following are some common examples: (Note that global and national MyChart EMR records now give access to patient medical information and have greatly improved providers’ knowledge of documented patient information.)

1. A patient comes into the emergency room or the clinic reporting a “terrible headache” and is nauseated and dizzy but denies a history of hypertension. Vital signs reveal a dangerously high pressure, but the patient defines themselves as non-hypertensive because they are normally prescribed hypertensive medications, so they consider themselves “cured.” This is a much more common thought process than is understood, especially for elders.

Further nursing triage reveals that the patient is “between” PCPs (very often this is code for the patient’s dislike for their previous one and so they just quit going to visits) and the patient has been out of their medication for two months (due to an inability to cover changing Medicare/other insurance costs). This knowledge prevents the ordering of further hypertensive medications (for perceived acute/undiagnosed episodes) by the ER physician or urgent care clinic doctor which could cause a dangerous drug interaction and/or overdose because the patient is very likely to refill the original medication as well at a later date. This is another common problem among elderly patients, especially. Gaining a full picture of the patient’s circumstances in this situation will also predicate running lab tests which may have not been ordered otherwise or ordered differently. This would offer additional insight to the patient’s current cardiac and renal status/risk in association with current signs and symptoms.

Nursing also contacts the inhouse social worker to assist the patient in funding available to cover the cost of medications and to elicit a list of PCP’s in the immediate area that take patient’s insurance (this is providing SW is as thorough as expected.) Nursing also provides a follow up call a few days after the visit to ensure that patient has had their needs addressed.

2. Patient presents with guarded abdominal pain. Their eyes are dark, their pupils pinpoint, and they are jittery and talking fast. The nurse notices skin irritations and sores and a “slack jaw” appearance in the patient. Many physicians immediately write this patient off as an addict, document “drug-seeking behaviour” as cause for visit and stop there. This has been both my personal and professional experience. Given the patient’s appearance which concurs with heroin/meth addiction, this may be a correct standing diagnosis. However, there is always more to know and investigate. This patient is a human being in need of care and thorough assessment. The pain the patient complains they have often has another root source besides withdrawal. The nurse notices after the doctor leaves the exam room that the patient winces when standing and limps on the right side. An astute nurse will pull the physician back in and subsequent due diligence medically reveals appendicitis. A life is saved.

*A more frequent finding with patients in addiction is bodily injury due to violence perpetrated against them from the population they associate with. Since shame is a huge factor in this group, the patient will often not divulge a criminal act against them and associated injury is easily missed in assessment.

3. Patient complains of generalized dizziness and imbalance. She mentions that she notices one side of her body seems to be “lagging.’ The neurological “tug” test is performed along with the routine balance test. No present abnormalities are observed, yet the patient insists she is experiencing increasing episodes. Although labs are ordered to check for abnormalities in hydration, glucose, and possible tell-tale results of a recent stroke or myocardial infarction (cardiac enzymes and CRP), they come back normal. As the physician is writing discharge orders for PCP follow-up recommendations, the nurse checks in with the patient.

The patient is sitting with her head down. Her off-handed mumbled comment catches the nurse’s attention. “I feel like I’m literally living in darkness and am scared most of the time.” This comment strongly hints at mental health issues. Adverse mental health conditions that are left untreated will absolutely affect the body (altered stature, weight balance, gait, eye movement, posture, cognitive word halt/jumble.) Upon further assessment, the patient also reveals long-term anxiety-related insomnia, one hallmark (though not entirely definitive) of compromised mental health.

A discussion with the doctor now adds a psych evaluation, a mental health consult to her PCP follow up and community referrals. The patient’s time is not wasted reaching out to the medical community because a nurse made the decision to follow the cornerstone of his/her medical training to observe/listen to the patient. Nurses are taught to observe both the presence and absence of information and body language and many other factors. The picture presented when first meeting a patient is most often just the tip of the iceberg.

The Benefits Of Honoring and Respecting One Another as Providers

When physician and nursing roles support and complement each other’s expertise and knowledge, and each respects the other’s insight and practice, great results occur for patients:

• a much more in-depth picture of the patient’s overall physical and mental health is revealed.
• potential risks and needs that often go unidentified are exposed.
• the patient receives a much more comprehensive, relative treatment plan.
• patient trust in the medical community increases

Better patient health is achieved, and a much-needed deeper level of patient trust in their care team begins to be restored.

Unified medical forces create reliability and safety for all involved.

Patient compliance is directly related to patient trust for their provider.

When physicians respect the nurses they work with and understand that good nursing staff are an immeasurable source of support and diverse medical knowledge, the target of healthcare, patients, benefit the most.

They are why there are doctors and nurses in the first place.

The post How Physicians Benefit From The Experience and Knowledge of Nurses appeared first on Medika Life.

Part of society deems it honorary, while another views it as workhorse. Still another sector, physicians, oftentimes respond to nursing personnel as though they are invisible, inconsequential creatures. The reality is that the expertise, knowledge, training, and intuition that constitute a good nurse, create an absolutely invaluable, supportive role in medicine and in society. This fact is the focus in this essay.

Nursing credentials come in two forms, the LVN and the RN. Both are licensed. Both have the opportunity to engage and join in one or more of several affiliations that support nursing roles and create opportunities for advancing knowledge and certifications in specific nursing specialties. The LVN requires two years of pre-requisites and 3 following semesters of nursing school. The RN requires two years of prerequisites and 4 following semesters of nursing school. Either profession may continue to BSN or MSN status.

The Unique Qualifications of Nursing

The LVN and RN learn and utilize life-preserving and life-saving skills that progress and sharpen with daily use. Each patient interaction requires moment by moment professional medical judgment to exercise consistent patient care that fosters both health and safety, optimally. No patient, case or shift is ever the same. This reality requires the nurse to be vigilant and up to date in the practise of medical knowledge and skills, such as medication administration/knowledge or the knowledge/practical execution of appropriate interventions and/or triage assessment of/for health-compromising insidious symptoms easily misunderstood, ignored or missed.

Professional positions in a society must meet some important needs of the members of that society. Nursing supplies human beings with preventative healthcare, emergent healthcare and supportive healthcare, which is a most basic biological need of humankind. Most lifelong nurses will agree that to enter the nursing profession is indeed a life purpose and calling. Those who do leave the field usually do not do so without much brooding and conflict, as caring for people is usually interwoven into a nurse’s physical and emotional makeup and is very difficult to break from, professionally and personally.

To be successful in the nursing field, the nurse must always be open to learning about the co-disciplines involved in patient care and in cross-training in new specialties. This gives the nurse opportunity for a deeper understanding of patient perspective and experience, provides the mastering of all skills required to care for and treat diverse patient groups/needs and also increases flexibility for advancement in their career.

The resources available for nurses to continue in and to support their professionalism are Continuing Education Credits, medical seminars, and opportunities to educate patients through pop-up clinics/speaking engagements.

As a nurse hones his/her specialties, they are able to have increased autonomy over their schedules, which provides the freedom and time to focus on their own expression and direction of the profession (such as online courses/blogs/teaching materials), which they have personally designed.

Professionalism Is Actually A State of Mind.

Although not every job is a profession, every employee has the capability to be a professional in moral and in integrity.

Nurses are absolutely required to have the highest integrity and moral values and to carry out those characteristics with every patient they encounter, without a trace of judgmentalism.

Not every person faces a job with conviction or investment in the counterparts, but most nurses do, as the counterparts are people and people are why we do what we do.

I enjoy my profession as a nurse because I have had daily opportunities over the past thirty years to love and care for the precious human beings on this planet.

Professional, committed nurses make the medical world go ‘round.

The post Nursing: Defining A Profession appeared first on Medika Life.

Earlier that day I passed an ICU doctor for the 20th time, as we often do running from room to room, donning and doffing the PPE.

“Are you having a better day?” I ask him.

“No. I’m just having another day,” he tells me.

“Well, sometimes that’s all we can ask for,” I reply. “The sun coming up”.

The only problem is, we want the sun to come up for everyone.

I often wonder how many thousands of nurses had the same conversations as me that day; Encouraging doctors and patients alike to keep fighting.

I walk into my patient’s room one last time before shift change. The respiratory therapist has already been paged. The decisions have been made, he just doesn’t know it yet. Our governor just announced we have no ICU beds left and I wonder where they’ll put him. I tell him,

“Hey, call your wife ok?”

Then I hold his gaze until I see the realization wash across his face. In a few minutes, he’ll be one step away from a ventilator.

“O.K.,” he says as he lowers his head.

“Hey!” I tell him earnestly, getting him to raise up his chin once more,

“You call your wife, then you fight like hell.”

And that’s the story of how I came to be sitting on this bathroom floor. Wishing I wasn’t here, but finding it so hard to leave…

The post Call Your Wife; Then Fight Like Hell appeared first on Medika Life.