Tuesday, May 11, 2010

Dirty Little Secrets of Nursing, Part Four: It's not doctors directing your care.

I got into the same conversation this morning that I do every week, with the guy stocking produce at the local Crazy Grocery Store.

"How you doin'?" he asked.

"Inelegant." I replied.

"You look fiiiiine" he said, grinning and showing his two gold teeth.

We talked today about the time he spent in the hospital a few months ago. "Those doctors saved my life, you know" he said.

I didn't want to tell him this, but it was probably the nurses in the ICU here at Littletown General that saved his life. I know the doctors who cared for him, and I know that they're not around that much.

It's a dirty little secret of nursing: those handmaidens and helpmeets who take a subordinate role to the great Medical Deity are the ones directing your care. Nurses are the ones keeping an eye on your electrolytes, your fluids, your nutritional status, whether or not you're running a fever. Nurses are the ones, often, who decide whether or not you need a central line or a tube running through your nose down to your stomach. We're the ones who push for that indwelling bladder catheter. We're the ones who yell and screech when something goes wrong.

Nurses have more input into a patient's care--even including, sometimes, their surgical course--than most civilians recognize. I had a patient with a belly bleed the other day who was doing okay...but if he hadn't been, it would've been up to me to provide the information and the observation that would've been the deciding vote on whether to take him back to surgery.

If a patient codes, nurses run that code, doing compressions and giving meds, until the code doc shows up. That might be two minutes, or it might be twenty--or it might be never. I've taken part in three codes during which the code doc didn't show up until well after we'd gotten a steady rhythm back and the patient intubated and stable.

This makes sense, if you think about it. I'm there for twelve hours, taking over your care for a colleague who's been there for twelve hours. In the CCU, that means that I've been in your room a minimum of once an hour for that long shift, keeping a watchful eye on your vitals, waking you up regularly (sorry) to make sure nothing's changed with your mentation. The doc will visit for fifteen minutes in the morning before rounds. He'll spend ten of that fifteen minutes with me, five with you--enough to reassure you that all is going well, and to get a clear and comprehensive picture of what's actually going on from me.

In the specific case of my asparagus-stocking buddy, it was the nurse who had him for four nights in the Littletown ICU who noticed his crazy heart rhythms and suggested, not gently, that perhaps an implanted defibrillator was in order. It was because that nurse had pulled and saved EKG strips that the docs realized that yes, the nurse was right: dude was hovering on the edge of a heart attack. I don't know whether that nurse was a guy or a girl, or whether it was somebody with thirty years' experience or someone I graduated with, but the point remains:

It's a dirty little secret of nursing: sometimes we control your care.

14 comments:

The Future Missy Prissy RN said...

Another fantastic post I must say!!! Brava!!!

NurseExec said...

I'm quite sure that every nurse on the planet has heard a patient say "those doctors saved my life" at some time or another during their career and flinched. I know I've wanted to say "Ummm, no, it was me" more than a few times, myself, especially during my open heart ICU days. Thanks for a fantastic post.

susan said...

Truer words were never spoken.Right on.

Liz said...

Excellent!

This is why I don't watch 'House'...

Anonymous said...

Jo, thank you. A friend posted the question "would you rather be a doctor or a nurse, and why?" on facebook the other day. Most people didn't answer the "why" part, but one response was "I'd be a nurse because I'm more of a care-taker than a decision-maker."

I was infuriated. But also, it really is the public perception that nurses are subservient to doctors, and play very little part in determining the course of patient care.

I'm giving our graduation speech on Saturday and would like to touch on this issue. Thanks for giving me some more food for thought. :)

-s(not for much longer)nurse8

RehabNurse said...

Oh, jo, how often I scream when I see the obits who say how "Dr. X was so wonderful" and they forget the nurses. Not even one mention.

One I saw recently mentioned the docs, (this was a hospice patient) but also every single other person the hospice team sent out--nurses, aides, chaplains, social workers--by name (first only).

If I were at that newspaper, I'd tell all my people to remember that...the team makes it for you, not just one stinking doc, especially in hospice.

I love and revere some of the docs I know, but they ain't doing the heavy lifting, if you get my drift.

Thank the people who are.

AfterGirl said...

Yeah, spend some time in a hospital with your elderly parents and you see right quick who does what. Sometimes I wonder why the doctors even bother to come in the room.

messymimi said...

It bears repeating until everyone one earth knows it and BELIEVES it:

The doc sees you for 15 minutes a day, and counts on the nurse to keep his/her butt out of a sling the other 23 hours and 45 minutes.

Anonymous said...

This is why Momma always taught me that I should be polite and respectful to nurses, cooks, mechanics, and bartenders...especially nurses!

Coffee Run said...

It appears that, ultimately, wars are always fought in the trenches...

Moose said...

And sometimes it's very clear Nurses are controlling your care, and this is a very good thing.

99% of the time it's great. The occasional bad apple, however, continues to scare the panties offa me.

I think it says something that I'm more scared of bad Nurses than bad Doctors.

(But for every "Bad Nurse" story I can think of, I can think of 5 "Fantastic Nurse" stories.)

ThirdDegreeNurse said...

Moose -- well spoken. I, too, am alot more scared of Bad Nurses. I can't really say in my organization that nurses run the show, but we have a pretty good hand in directing the residents' orders. A good nurse can make it or break it.

Anonymous said...

The real nursing secret is that nurses set the pace of patient care. Management wants to make nurses speed up to make more money. When in actuality, if nurses slowed down and took time with patients, the powers the be would have to hire more nurses to expedite their wishes eliminating the nursing shortage. There is no shortage, this is a farse, there is a shortage of people willing to pay what nurses are worth.

Anonymous said...

The real nursing secret is that nurses set the pace of patient care. Management wants to make nurses speed up to make more money. When in actuality, if nurses slowed down and took time with patients, the powers the be would have to hire more nurses to expedite their wishes eliminating the nursing shortage. There is no shortage, this is a farse, there is a shortage of people willing to pay what nurses are worth.