I will be your nurse today. As such, I want to make just a couple of things clear.
I do not love your loved one. I do not share your history, memories, admiration, or intentions. I do, however, care that he or she receives absolutely the best care possible with the best outcomes in mind. I will stop at nothing to make sure pain or other discomfort is relieved, you are kept in the loop, and the doctor has all information necessary to make informed decisions about the treatment plan. I will do oral care, peri care, skin care. I will turn and reposition every two hours at a minimum. I will comply with all measures to prevent pneumonia, UTI, DVT and ulcers of the gastric and dermal varieties. I will monitor vital signs, lab results, and perform an initial as well as ongoing physical assessment. Sounds good, right? Now let's talk about what prevents me from doing this.
1) The doctor disagrees or won't listen to my findings. In that case, I'm bound and constrained by his or her orders. No matter how much you think differently, short of you contacting the doctor directly and duking it out, there's not much I can do. The corollary to that is if the doctor is practicing negligently or unsafely; in that case I have a chain of command I may utilize to rectify the situation. Grandma's super expensive, noxious smelling lotion does not qualify. Don't ask again. And don't put it on when you think I'm not looking. I'll smell it and wash it off. There are reasons for that that you don't know and no, I'm not going to explain it to you. It falls under the category of "because I said so."
2) I do not have the ordered medication, treatment, etc currently. In that scenario, rest assured I am working to get it. The more urgent it is, the more persistent I am in getting it. But if the treatment happens to be something like "clean patient's toenails" and I have another patient in pain, you lose. Routine chest xrays for a patient not in distress or not intubated are about mid-level on my list of priorities. If you come out to get me to ask me to pour water from the pitcher to the cup in your family member's room, you lose.
3) You. Pretty simple, isn't it? Your demands for the same information repeatedly, for things that are nonurgent in nature, or your bad attitude can all factor into the mix. I will be totally honest here: if you are an asshole, I and my coworkers will minimize our time in the room and interaction with you when at all possible. Realize that screaming at the top of your lungs that you have things to do and you will not wait for me to contact the doctor does nothing but make me walk a little slower to the phone. I won't be checking in when I have a free minute just to see if your loved one needs anything. Us wanting to be away from you means we're not in proximity to our patient. Don't get me wrong, we won't ignore the call light or allow anything untoward to happen physically. We can see all of his or her vital signs on our slave monitors outside the room and we're watching them. We're also probably watching on the camera. But we're not going in the room until we absolutely have to.
Another way to guarantee a tight lipped, minimally interactive nurse is to attempt to do what we call "splitting." That's when you tell someone who wandered in to answer your call light how much better they are than your current nurse. We talk amongst ourselves; we know when you pull this stupid shit. Or when you ask one doctor if he agrees with another's assessment and plan. Here's a tip: even if he doesn't, he'll never tell you.
If I have to part the seas because you and your family, extended family, neighbors, acquaintances, postman, pastor, and dentist are piled three deep at the door I will avoid the room. And possibly call security. How are you irritated by the lack of practitioner presence when no one can even get in the damn door, much less walk across the room to your family member? There are visiting guidelines for a reason. Oh, and here's another tip: because of the recent H1N1 outbreak, we are following the CDC guidelines on visitors. Which means no one with flu like symptoms, no more than 2 people in the room, and no one under the age of 16. Period. And just stop your sputtering to think about this for just a second: knowing how many people around you potentially have H1N1, never mind MRSA, VRE, C.diff, why would you want to bring your infant/toddler/child/tween in? And that's just the stuff people know about. The people in the beds are protected for the most part. You aren't. And neither are your kids.
Lastly, I'm not a member of a "death panel" so no, I don't want to kill granny. But I also don't want to flog granny. This is pretty simple to translate: granny has reached the ripe old age of 81/88/92/whatever. She has Alzheimers, arthritis, gout, heart disease, TIAs, diabetes, obesity, peripheral vascular disease. I do not want to shock her to restart her heart. I do not want to break her ribs doing compressions. I do not want to put her on a ventilator that she'll never come off of which will then necessitate a tracheostomy and feeding tube. I personally don't care if she's a chemical code; all we're going to do is put drugs in her noncirculating circulatory system. If you love granny, you'll request I withold electrical therapy, CPR, and artificial respiration. You'll at least listen and think about enacting comfort measures. Yes, we'll put her on morphine. No, it won't kill her. Yes, she'll go out of the ICU. No, she won't be ignored. She'll go to a floor where people do comfort care for a living and the nurses are accustomed to guiding patients and families through the dying process. Let it happen. And do not. Do not let me know that you want me to prolong his life so you can continue getting his checks.
You do your job. Let me do mine.
