A Mother and a Nurse

Kristy Rodriguez, BSN, RN, works as a nurse in Florida.

As a mother and a nurse, I have often found myself with the dilemma of whether to inform others in a health care setting that I am a nurse. I say this because it can go either way: some look at it as a blessing that they can easily explain things to you using medical terminology, while other nurses may take it as a threat. And I understand these concerns. As a nurse I have come in contact with both attitudes—the helpful and the threatening—among family members and patients who work in health care. It has been helpful to have a family member or patient who understands at least the basics and is eager to learn. Then, on the other hand, it can be a nightmare with the patient or family member who uses the statement “I’m a nurse” as a kind of threat.

A son’s troubling symptoms.

My story all started about three years ago, a day that my son’s life would forever be changed, and mine with it. It was the spring of 2012 and my son was 12 years old and developing as a normal boy should develop. A stomach virus had recently swept through our house and sickened my son and […]

2018-09-28T14:34:00-04:00September 27th, 2018|Nursing|2 Comments
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What the Patient Knew: Communication and Patient Safety

Anticipating emergencies.

by rosmary/via Flickr

At the start of every shift after receiving report, I take a moment to consider what emergencies I might anticipate for my particular patient in our PICU. Monitor for excessive bleeding in a liver failure patient. Monitor for an altered neurological status in a patient with a head bleed. I try to envision how I would start CPR in the room if required. I try to be thorough in checking that all my emergency equipment is present and working. I try to keep patient safety at the forefront of my mind and priorities.

I came to work one day and received report about my 9-year-old patient who was post-operative day one from a planned craniofacial surgery. He would remain nasally intubated with eyes sutured shut for a few days until the swelling had reduced, and then would return to the OR to be extubated and to have the eye sutures removed. I’d had patients like him before and felt he would be very easy to keep safe, especially given that per handoff report, he was comfortably sedated and not overly agitated when he did briefly waken with nursing care.

A patient’s question.

As I got to know him through the first couple hours of my shift, I found that he was indeed comfortably sedated though […]

2018-05-24T10:08:09-04:00May 24th, 2018|Nursing, patient safety, Patients|0 Comments
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The Nurse’s Temptation to Fill in the Patient Handoff Narrative

The limitations of handoff report

In bedside nursing, the nurse enters the story of the patient’s life at the point where the handoff report ends.

“Pt is an 8 mo old female, history of hypoxic ischemic encephalopathy (HIE), baseline 2L oxygen at home. Admitted to the unit for respiratory distress.”

Handoff report then goes through a systemic description of the patient’s current state: neurological, cardiovascular, respiratory, GI/GU, skin, and finally, psychosocial. The report is thorough but brief, never truly complete.

The oncoming nurse takes report and seeks to develop an accurate picture of her patient’s physiological state in order to anticipate emergencies and prioritize nursing interventions. But as any experienced nurse knows, no report can replace thorough and ongoing assessments—patients can change, and even the most expert nurses who have previously cared for this patient can miss details.

This holds true both in terms of a physiological assessment and a psychosocial assessment. What the nurse receives during handoff in terms of the patient and family’s psychosocial status is typically brief. “The patient’s parents are involved. Dad is a little more anxious and doesn’t stay at the bedside for long. Mom has a lot of questions, and she likes to help a lot with the hands-on care.”

Assumptions rush in to fill empty […]

2018-04-23T10:26:19-04:00April 23rd, 2018|Nursing|2 Comments
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A Crucial Public Health Lesson: Let the Women Speak

” . . . people have their own hope and power which they need to discover.”

Illustration by Gingermoth for AJN.

Do some public health projects fail to live up to their ambitions because they were conceived in a conference room rather than in dialogue with those they are trying to help? It seems possible. Terms like client or community “buy-in” are now fashionable, but maybe what’s really meant by such terms is that people are given a chance to state their needs and their concerns ahead of time. And that someone is listening.

In this month’s Reflections essay by nurse practitioner Mark Darby, he remembers a valuable lesson once imparted to him through example by a Dominican priest. “Shut Up and Let the Women Speak” doesn’t flatter the younger version of the author who once visited the Dominican Republic on a medical mission. […]

2017-12-11T08:37:50-05:00December 11th, 2017|Nursing, nursing stories, Public health|0 Comments
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Learning New Skills of Supporting One Another as Nurses

I have had a couple of recent conversations with nurse coworkers who have been close witnesses to patient deaths that were particularly difficult. They told me how challenging it was to process the experiences with fellow nurses—even those whom they considered as good friends—in the hours and days immediately following the patient deaths.

Some conversations in the break room or in carpool rides would go into the medical details surrounding the deaths, but stayed away from discussing personal emotions beyond general statements such as “It was just really sad.”

Other conversations, they told me, were comprised of awkward silence—as opposed to a more intentional therapeutic silence, a deep listening. In both scenarios, my coworkers said they’d felt a lack of quality and depth in these encounters. While they hoped for an opportunity to talk with colleagues, who would surely understand the experience and details better than anyone else, ultimately they felt that they were left to sort out their thoughts and feelings alone.

Even in a unit where we constantly express gratitude for a strong sense of teamwork, my colleagues and I still struggle to help each other through the deeper experiences of grief and trauma.

A missed opportunity?

And at times when I’m in the charge nurse role and staff members are responsible for end-of-life care, […]

2018-01-18T10:02:53-05:00October 20th, 2017|Nursing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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