Dear Nightingales and Friends,
So, funny story…A doctor and a nurse walk into a patient’s room.
The doctor says to the patient, “Can you tell me who the president is?” The patient does.
The doctor then says to the patient, “Can you tell me today’s date?” The patient says the correct date.
The doctor then says to the patient, “Can you tell me where you are?” The patient says the correct name of the hospital and the name of the unit he is in.
The patient then looks at the nurse, who steps forward to the bedside and says to the physician, “You don’t need to ask him all those questions. Just ask him what Rule Number One is.”
The physician looks puzzled, then looks at the patient and asks, “What is Rule Number One?”
The patient looks at the doctor and then looks at the nurse and says, … “Always keep the nurse happy!”
The patient and the nurse smile and look at each other and the nurse says to the doctor, “He’s fine. We’re going to have a great day.”
True story… he was one of my patients.
From the beginning of nursing, nurses have had a VIP seat in the inner circle to a patient’s experience in healthcare. Whether it is in a hospital, a procedure, a clinic, a telephone triage call or in a home health visit. We are the ones who see the big picture.
Nurses are the ones who know what it is going to take to get an IV line in a patient who is 90 years old, has kidney disease, takes Prednisone and is dehydrated… and why there are so many bruises.
Nurses are the ones who know that there are at least 4 ways to give medications to an elderly person who has trouble swallowing. (1)
Nurses know even though a physician orders a regular diet for a patient with strep, mononucleosis and swelling in his throat so badly he can barely talk… that there are 2 good reasons, I will only give him clear liquids. (2)
Nurses know that when a trauma anesthesiologist asks for Vecuronium (a paralyzing medication) so he can put an arterial line in a patient who has tremors after a head injury, but who is not on a ventilator… it is necessary to refuse that order, dismiss that physician and ask for another.
Nurses know how to explain to a patient what it feels like to have a foley catheter placed.
Nurses know to explain to a patient with end-stage COPD who is frantic, sweating, short of breath and scared… what the Bipap is going to feel like, why I will give them Ativan, and why I will NEVER say – or allow my students to say, “Just relax”. And instead, will hold their hand, talk to them, or sit next to them and hold them while the medicine takes effect and their breathing relaxes.
And, why, I ask my nurse orientees or students or even the patient’s family, to try the Bipap mask on and see what it feels like… so they don’t say, “Hey Mom, just relax!!”
Nurses know that when a patient wakes from being on a ventilator, even though their eyes are open and they are looking at you, class is not in session. It is not a good time to review the whole case, or get consents for procedures. (Maybe a good time to ask them to promise something… because they won’t remember that they did.)
Nurses know that even though a physician has discharged a patient home because physical therapy said they were safe to go home without rehab, if I have to yell for help to get a chair when I am getting the patient to the bathroom… I am not discharging that patient, and that physician is getting a phone call… because I was the only one who asked how many stairs there were to get into his house, and up to the bedroom and he can’t even walk 20 steps into the bathroom without almost falling over and I have to catch him.
Nurses know that sometimes keeping a patient alive with extraordinary measures including a ventilator and emergency blood pressure medications despite knowing the patient is going to die anyway, is to wait for a loved one to arrive so they can kiss their face, touch their hand and say goodbye.
Nurses know the story behind the curtain… when the physician leaves and the care begins.
If you would like to know what happens when the doctor walks out of the room, finishes a procedure or writes an order…
Call me today… I can help you understand what happens next… and how using the Federal Rule of Evidence 1006 Summary can help you tell what the patient went through.
Helping You Find The Answers
Audrey Friedman RN
(And here are answers to #1 and 2…
1. Crushed in jelly, pudding, ice cream or applesauce.
2. Any food other than clear liquids has a high risk for obstruction which would block his airway, or, perforation of his esophagus.)
[Original Post 06/22/2015]