Observation Skills WIN

So last night at work we emptied out for the holiday weekend, but-as always- emptying out can only mean one thing....Admissions. And lots of them.

Well, every nurse has their "thing" that they really prefer not to do if they can avoid it. My "thing" is admitting people. It makes me anxious, the unpredictability. From the first moment we get their information called up to the floor, nurses try to predict what their patient will be like. Based off their diagnosis, what problems will we encounter with them when they get to the floor? What will we be doing for them? Based off their age, what do we need in the room to accommodate their needs? Based off the Doctor, is it an attending and we won't have any orders all night? Or is it a hospitalist and getting orders won't be a problem?


However, admitting/ER sometimes ***forgets*** to tell us certain things about the patients because they don't want us as floor nurses to freak out and try and "divert" the admissions. So, usually the common result is we get patients admitted for one thing and turn out to be a complete psycho. Or they come up screaming, when the diagnosis is something not scream-worthy like cellulitis. Or, sometimes, they totally come up handcuffed to the bed with a police officer with them, because they live in....the jail. And they are violent and loud and not cooperative in any way. And the admitting department just *forgot* to give you a heads up.


Well, last night I get an admission called up. Pneumonia, older gentleman. I figured it would be pretty routine. Patient feels like total crap after multiple days of failed attempts working cold medicines at homes. We get them situated, start some antibiotics, nebulizers, get them to sleep, etc.

Well my "pneumonia" guy comes up on the stretcher, with nothing less but a city cop- hand gun, their little walkie talkie scanner thing, badge, uniform, the whole get up. Legit.

So I'm like, oh- fabulous. I mean a nurse cares for her patients regardless of their status. Regardless of race, age, gender or poor life choices. But still, I wasn't thrilled about the idea of listening to a prisoners bowel sounds that might spit in my face.

Before entering the room, I so badly wanted to pull the cop over in the hallway (ha-ha, no pun intended) and ask what the patient *did*. But I didn't. I decided it didn't matter and I didn't want to know anyway. I was going to care for him the same no matter what.

So I start my admission assessment, composed of a whole bunch of questions about the patients history. The patient is elderly, a little scruffy, tall, lanky. Not your typical prisoner type, but then again who am I to know what a typical prisoner looks like besides whats on TV?  So as we discussed his medical background, the cop kept chiming in, "Oh, you had that ulcer right? And that lung cancer, you had the chemotherapy for 30 weeks, right?"

So I'm like, Wow- This cop really knows a lot about his inmates. He must have been in this jail for...a long time. Wouldn't that be the state jail? I don't know much about our criminal justice system. Clearly.

So I go about my clinical hands on assessment, trying to keep my guard up for any *sudden* movements from my patient, noting that for some reason he wasn't handcuffed to the bed as all prisoners usually are. And why is he in penguin sweatpants?

So then comes a question that we have to ask. Who do you live with? Do you have a support system? If so, who? I always think it's an awkward question, prying into personal lives as such.

So this is how this short lived conversation went down that made me look like a total idiot, which- I am.

Me: "So...........You live with.....I mean, In.............the....jail?"  I make awkward eye shifting contact between my patient and this cop. The patients facial expression was pure confusion and therefore I felt the need to verify my statement with looking at the cop. Awkwardly. Long pause.

Cop: "Oh! OH! NO! noooooo. Oh! I'm his son! I'm on shift, they just called and said he was over here."

Me: "Oh....I was wondering why he wasn't handcuffed to the bed."

Patient: "Do I really look that bad?!"

Me: "No! No of course not!"


Thank goodness we all had a good laugh over it but I was seriously kicking myself. I should have known when I saw the penguin sweatpants.


I went and told my coworker the story, thinking it would be totally suspenseful and she wouldn't guess that the cop that came up with my patient was actually the son in the end. Instead she's all like, "Didn't you see the cops badge? It was totally the same as the patients last name."


I win the super award for naivety because she was with this patient for like 2 minutes and I was with him for 45 minutes and I didn't notice the nametag. Super observations skills WIN.



-A Writer in an (unobservant) Nurse's Body


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