patients – Sheila Dougal

Nursing : A ministry of dignity

I’m up late. Tomorrow I’ll start working night shifts at the hospital where I work as an Acute Rehabilitation nurse. It’s just temporary through the end of the year when I’ll complete my BSN… finally ( it only took 18 years).

I’m up late doing research for my Capstone project. It’s about how the nurses at my hospital can implement change to prevent our often elderly patients from acquiring pressure injuries (A.K.A. bedsores). And all this research has me thinking about what motivates nurses and how much healthcare in the U.S. depends on nurses.

Nursing is not a lesser version of practicing medicine. It’s a way of honoring the dignity and worth of another human being through giving wholistic care, instruction and resources for the person’s good. But so often, especially bedside nurses, loose sight of what it is they do, or rather they’re disillusioned by what they do.

The pressure on bedside nurses from hospital managers and administrators is to perform complex, fast-paced deliver of tasks and medications and education… endless requirements all documented to a T in 12 hours. The pressure from the bed (patients and family members) is often (not always- there are many thankful and inspiring people in those beds) to provide 5 star resort pampering. The pressure from our peers is often to act like we have it all together, like we don’t need help, like we can do anything. And all this pressure has many nurses loosing sight of what’s really important: human dignity. Our own, and our patients’.

This is where, for me, being a Christian nurse is so freeing. The yoke of hospital nursing in America is heavy, but Jesus’ yoke is light.

I don’t have to please the system, or please the patient even, I have to honor the Imago Dei in every one of my patients. When I make human dignity the aim of my nursing care, all the rules and regs and complaints fall like broken chains.

There is a healthcare crisis in the U.S. The fastest growing portion of the population are over 65 and many don’t have the resources or support to get the care needed to live and die with dignity. There is a shortage of nurses in the U.S. and many are part of that fast-growing retirement age. Chronic disease plagues half of our populous and many don’t get the treatments, medications, appointments and care they need. Center for Medicaid Services has lists and codes and rules that make navigating the healthcare system a daunting task. Amidst the dark maze of U.S. healthcare, nurses who value human dignity are respites of light.

Dear nurse, I know you feel overwhelmed. I do too. But stop and remind yourself, you’re a nurse. Not a doctor. Not a medication-technician. And you’re not a slave to the hospital or healthcare company you work for. You’re a nurse. A minister of help, hope and heart. You are a minister of dignity. Our healthcare system is a mess, but that person in that bed, no matter how nice or how cranky, how dependent on drugs or how debilitated with cancer, is a person made in the image of God. And like Daniel Darling wrote referencing his surprising response to Horton Hears a Who:

‘Yes,’ I thought, “every person really is a… person, no matter what their usefulness to society, no matter how seemingly insignificant they are, no matter what their stature.”
A person’s a person. What a thought for our strange and confused age. – Daniel Darling, The Dignity Revolution. p.14

I’m not a medication technician. I’m a nurse.

I met him at the time clock.

“How are you?”

“Great, now.” He smiled reaching for the barcode side of his badge to swipe out.

It was the end of our shifts. He worked the observation unit where patients stay in the hospital for less than 24 hours. He admitted 4, discharged 4, so had a total of 12 patients that shift. “Not that bad actually…” he reasoned. Usually it was more like 16 or 18 patients a shift with the rapid turnover, or thoroughput as the hospital administrators like to call it.

We walked into the elevator together lamenting the fact that we have degrees in nursing-which is a theory of practicing healthcare that is born out of service and caring for the whole person- but we are defacto medication technicians.

We pass meds, answer call lights, document idividualized plans of care, Braden scores, BMAT’s, NIH scales, head to toe physical assesments (that we’re basically filling in the blanks for cause we literally had 55 seconds in the room before being called out to talk to Dr. So and So), intake and output, vital signs (because we’re short on nursing assistants), Functional Independence Measurement scores (in perfect detail after noon and before the end of the shift because Medicare thinks we’re forecasting care if we capture it in a chart before noon. Newsflash Medicare: WE ARE FORECASTING. IT’S THE ONLY WAY THIS REQUIREMENT WILL GET DONE)… I could go on and on. But all the time we spend with our patients is mostly given to documentation and passing meds…. we barely get time to squeeze in a really good asessment, much less time to educate our patients, listen to them, and collaborate with others for their good.

We’re nurses, not medication aides. But at the end of a 12 hour shift of being interrupted every 55 seconds we cling to making sure our patients all got their medications and all the required charting is done as the evidence that we did something meaningful all day. And we hate it. We don’t want to just pass meds and chart. We want to nurse.

Nursing is not an assistant to practicing medicine. Nursing is a way of practicing healthcare. It’s wholistic. It listens. It touches. It serves. It cares. It instructs. It encourages. It finds resources. It researches. It collaborates. It leads. It values the image of God in people.

The healthcare delivery system in America, especially in hospitals, lays a heavy burden on nurses’ shoulders. But if we can see the value of what we’re doing and go to the person in that bed in need of a person to help them get better and go home, or die with dignity, we’ll drop the baggage of the U.S. healthcare system and become lightbearers.

At the end of a long day spent, I pray I can say my focus was the person, not the system.

I’m not a medication technician. I’m a nurse.

A PSA from a short-of-breath nurse: Don’t go to the hospital to get pampered.

(Image credit here)

Amidst the cacauphony of I.V. alarms, bed alarms, chair alarms, call bells, overhead pages for code blue, code purple, stroke alert, ringing phones and the chatter of nurses, nurse’s aids, doctors, therapists and social workers, a nephrologist walks up behind me at the nurse’s station where I’m trying to get a handle on my patients’ (all 6 of them) history, medications, lab results and scheduled tests for the day as well as doing my required log-on charting. (Deep breath… that was a long sentence and that’s usually how I feel about 5 minutes into my shift at work. Deep breath Sheila, deep breath).

The nephrologist asks a question aimed into the general vacinity of the nurse cluster.

“Who’s the nurse for room 22?”

Her question is nearly drowned out by the noise, but since I’m inches from her I stop what I’m doing, look at the nurse assignment in my hand, look up at the doctor and tell her the name of the nurse. No one knows where 22’s nurse is, so I call her on vocera. She answers. She’s in a patient’s room doing a dressing change, can I take a message, she asks. I turn to the nephrologist, who heard the radio conversation, and she says, “That’s fine, just tell her I started her patient on lasix and ordered some labs for the morning. Her blood pressure is ok, but she is very edematous. Please be sure to get an accurate weight on the chart.” And then she grabs her bag, and swiftly walks away, white coat flapping at her pace.

This little vignette, which took me a few minutes to write occurs non-stop for 12 hours on most hospital units. The fast-paced, noisy, environment that presents demands from signs, alarms, questions, comments, phone calls and call bells are all aimed at one person: the nurse.

I always say nurses are the filter for everything that reaches the patient in the hospital. And whatever the patient wants to reach in the hosptial, has to also go through the nurse. The fact that nurse’s are interrupted every 55 seconds by issues that require their attention, even if only for the time it takes to delegate that interruption to someone else, is nevertheless problematic where nurses are pushed to fetch high patient satisfaction scores.

I’ve been a nurse for almost 18 years and over the years the increasing demand to bring in these high patient satisfaction scores has largely been directed, you guessed it, at nurses. The reason is because the nurse is the filter. And there’s nothing wrong with being the filter. Nor is there anything wrong with wanting a patient to be satisfied with their experience at a hospital. But I take issue with the goal being patient satisfaction and not patient safety.

When nurse’s are pressured to be sure they deliver thorough assessments of their patients, detailed, accurate charting, and be the filter through which all things in the hosptial go to reach a patient, with the goal being a “happy costumer” and not a well-informed, well-cared for, safe patient, nursing becomes a juggling act with a fake clown smile. And it shouldn’t be.

Without fail, every shift I work I hear complaints from my patients, not about the poor assessment or education their nurse gave them. Not about the lack of kindness. But about the missing mayo on their lunch tray. That it’s noon and no one pulled the shades up. That they pushed their button 3 minutes ago and no one came to pick up their dinner tray. There’s an attitude of entitlement amongst many of the patients I work with and in part I think it’s due to a lack of understanding about what nurse’s do and what the hosptial and healthcare system is for. I think there’s a misconception perpetuated by hosptial advertisements that make people think when they go to the hospital they’re going to a 5 star resort. But it’s a hosptial, where people are really, really sick! And people, not robots, are taking care all those sick people.

Deep breath Sheila, deep breath.

I am a Christian. I believe deeply that loving my neighbor well, including my patients at work, is evidence that Christ is real and lives in me. I believe serving others opens the door for testimony of the good news of Christ. I’m all about loving people well. But catering to people’s desire to be pampered should in no way be part of what people expect when they seek healthcare or go to a hospital. There’s a distinct difference between love and pampering.

There’s a healthcare crisis in America. We are getting older, we are obese, have diabetes and are chronically ill. According to the CDC 1 in 4 adults in the U.S. has two or more chronic diseases. Heart disease, cancer, stroke, diabetes, chronic lung disease, alzhiemers, and chronic kidney disease are what many of us in the hospital have two or more of. And many of these are preventable. But there’s an attitude I’ve been sensing over the past couple years among my patients that concerns me. There’s an expectation to be pampered by the healthcare system and a lack of ownership for our choices. There’s a lack of willingness to learn or change. And there’s a lot of pressure on nurses to make us happy.

As a mom, I feel like this is antithetical to what it means to care for another person in love. Love does not rejoice in evil. It does not coddle. It does not pamper. It does not tell you what you want to hear when you have diabetes, heart disease, an infection and want the nurse to make you happy by bringing you extra ice cream.

I am not saying we should be rude nurse crachets to our patients. I’m saying we need to enter the healthcare system as patients being our own best advocates. We need to want to make changes in our lives so that we can be healthier. We need to want to know what medications we’re taking and ask questions. We need to learn about our diseases and how best to control them.

So in summary, as a PSA, from a nurse who very much wants you to be happy, in the long run, and healthy as you can be, please take ownership of your health. And if you enter the hospital, please go there to get better and get home. Don’t go there to get pampered.

*P.S. This post is not talking to people who can’t even access healthcare. That’s a whole other PSA aimed at Christian doctors and nurses and people in positions of power and it goes something like this: Taking basic care of our neighbor’s human body is the right and dignified thing to do. Stay tuned…

Nurses, we are our patients

Friday the 13th I became a patient at the hospital where I work. I had a robotic total hysterectomy with salpingectomy and cystoscopy. After years of battling endometriosis, and recently bleeding, pain and fibroid issues I decided it was time for the worn out organ to go.

Being on the other side of the patient/nurse relationship is strange. I joked on social media that I felt like a spy. I did, but not with intentions of busting anyone. Just more like an undercover agent gathering intel. I noticed some things I’ll take with me with when I go back to work. The main thing I noticed was the obvious: I was the patient, someone else was my nurse. I bring this up because when you’re the nurse, it’s easy to distance yourself from the patient and when you have to be the patient you get a reminder of how human we all are. Nurses, we are our patients. Our bodies get diseases and we have surgeries, we need medical care. We don’t seek out medical care as much as non-nurses. We tend to care for our own needs and avoid being the patient.

There are many problems in healthcare and nurses feel the weight of those problems. But what motivates us to do the difficult work we do is a genuine care and concern for the health and well-being of people. And those people include us. Nurses, we need to take care of our bodies, because our bodies are the ones caring for other bodies. And we need to embrace, encourage, guide and teach new nurses, because they are taking care of us!

When I was admitted to pre-op on Friday a PCA, new to pre-op checked me in, gave me a warm, anti-microbial sponge bath, and then she realized I didn’t have an armband on. She ran to the desk to print one, verified my name and date of birth and put it on… inside out. She apologized, I assured her it was no big deal. She fixed it and we went on to verifying what I was having done, applying my SCD’s (which by the way I love, and want to own… it’s like a leg massage while you sleep!). Then the overhead announcement came that the hospital is in “downtime”, which means the computers don’t work and you’ll have to document everything on paper. The nurse and PCA bemoaned the fact that this was going to mess their day up, and rushed to print labels so they could draw my blood before the printer stopped working.

In the midst of the nurse and PCA discussing the trouble with their downtime situation, the anesthesiologist popped his head in from behind the curtain, said he’d be doing my anesthesia, had to go to another case first but would be back. He’s the one I was praying for. If the anesthesiologist doesn’t get it right, things go bad fast.

Once the IV was in and the labels were printed and the circulating nurse for the operating room spoke with me, verifying all my important information, the gynecologist doing my hysterectomy came in and sat down on my bed, put her hand on my leg and assured me of what was going to happen and how long and such. My husband left my side with a kiss on the forehead and versed being pushed into my veins. I remember the O.R. Getting on the table, a mask on my face, hearing the voice of my doctor and nurse telling me to go to the beach for awhile. And the next thing I knew I was shivering, moaning and hurting in the recovery room.

In the recovery room for 4 hours, waiting for a bed to open up in the hospital for me, I was in and out of shivering episodes, and drugged sleep. Somewhere in there my doctor talked to me about the surgery… I vaguely remember images on a paper and the word endometriosis.

When I got to my room on the postpartum unit, the pain, shivering and nausea had taken over. Between dry heaves, my nurse asked me the admission profile questions, the lab came in to draw my blood, the CNA took my vital signs, two nurses came to check out my skin and look at my incision sites and noticed that my left hand was very swollen- my IV had infiltrated. And then I had to pee. That didn’t go so good. In fact it didn’t go at all. The nurse called my physician, attempted to drain my bladder with a straight cath (attempted, is the key word here… 3 times to be exact). For the next two hours I tried to breath, reposition myself in some tollerable position in that bed with those flat, plastic pillows and text family members and friends who were wondering how I was. The nurse tried a couple times to start an IV with no success, so the house supervisor came to my rescue with one swift poke to my left bicep. By 9 pm, I was throwing up, still couldn’t pee, three more attempts later, a congregant of nurses had a successfully placed a foley catheter so my bladder could empty. The last time I had that many nurse looking at that part of my body I was having a baby. Humbled, medicated, poked everywhere I could be, I hunkered in the fetal position and prayed for gas to pass, urine to flow and my pain to back off enough that I could sleep a few hours. I got two.

At 6 am, when the Foley catheter came out and the male student nurse came in with his preceptor, the countdown began: When I could pee, eat without puking and walk down the hall I could go home. By noon I had accomplished all three. The discharging nurse reviewed my medications, discharge instructions and precautions with me and my husband wheeled me to the car.

Things have improved tremendously in the past 24 hours. And I’ve been thinking a lot about how nursing is caring for other people. People like me. I’ve run across patients in the hospital who seem to forget their doctor’s and nurse’s are people just like them. They get sick, have headaches, fight diabetes, high blood pressure, endometriosis, cancer, have surgery. They don’t know all the answers. But they are in the position of doctor and nurse to help the person in the bed get to a place where they can go home and feel better. Nurse’s we need to remember our patients are people just like us. Patient’s your nurse is a person just like you. We all have needs at times that require the help of others. The nurses and doctors who cared for me weren’t perfect, but they were caring and did what they could to help me. And I’m so thankful! I needed their help.

When I go back to work in a few weeks I’ll be the nurse not the patient, but being the patient this past week has given me a more relaxed view of what I do. In all the pressure to perform it’s so important to give each other the grace, forgiveness and accountability imperfect people need. Patient’s need our help. And nurses are not perfect. But what we do for our fellow man to help them gain strength, function, dignity… it’s very God honoring. We nurses care for people made in the image of God. And sometimes we’re the people being cared for.