Not the Sense I Wanted

So, for anyone thats ever gone to nursing school, chances are you've heard of Patricia Benner's "Novice to Expert" model. The five stages depict what stage of nursing you are in based on your experience and performance. THe stages range from being a:

-  "novice", which means you are by-the-book, no experience, new grad.
-  "Advanced Beginner", meaning you have enough experience to help formulate future guided actions, you start developing your "nursing spidey sense"
-  "Competent", meaning you usually have 2-3 years experience, you start thinking about your patients long term goals and health, rather than just the textbook here-and-now.
-  "Proficient"- Meaning you have learned from enough experiences to modify plans, change others perspectives, teach others your skills, and your nursing spidey sense is pretty strong.
-  "Expert"- Well, here is where you're just awesome. You've been a nurse for a looooooooong time and your Nursing spidey sense is just out of this world.


Now, what exactly do I mean by 'Nursing Spidey Sense'? Simple. Let me explain.

At the stage of a Novice, which I was not too long ago, I was so scared with my patients. I saw the more experienced nurses (I work with a lot of 'Competents and Proficients') and I would witness them catch a patient going downhill pretty early. I thought, how did you know? What if My patient is suffering and going downhill and I missed something in my assessment? My assessment skills aren't good enough, what if I am missing something simple, or something huge that could save their life? The more experienced nurses on my floor assured me that it was important that I just keep learning and always doing my best, always being on guard. I listened.

Now, almost hitting my one year anniversary in nursing, I feel like I have graduated to "Advanced beginner", and suddenly, I don't have that constant fear. I know I have a LOT to learn, but I feel comfortable in my assessments. I can feel my nursing spidey sense definitely getting stronger.

Point being, At the stage of a Novice, you have no nursing spidey sense. None. Zip. You go by facts, whats presented to you, lab values, evidence. There is no "intuition" developing just yet that something is wrong without any evidence.

Although I cannot speak from personal experience, from what I understand, "Expert" is when that same intuition of the nursing spidey sense is at its peak. You can enter a room and look at a patient and you just KNOW that something is very wrong with that patient before you even lay a stethoscope on them.

So, my nursing spidey sense is helping me in a lot of ways. I like having that "gut feeling" developing...it comes in handy when its time to make a decision. However, there are ways that it can be a huge bummer.

For instance, lately I seem to have developed the skill/spidey sense (I'm not sure which you could call it), of being able to predict if someone is dying or not. Not necessarily on my shift (in fact I do almost anything to NOT let you die on my shift!), but I've learned enough in nursing to know when someone just simply isn't going to pull through whatever they are going through.

I had a very kind patient not too long ago. He touched my heart with his generosity and patience, he was a very sweet elderly gentleman and was going through a lot of hard times. He had advanced stage lung cancer and frequent bouts of pneumonia, due to frequent aspirations related to the lung cancer and intubations. Well, one day I heard he was discharged and doing a little bit better. Well, a couple weeks later, I was doing a small rotation in my ICU, and I saw a man in one of the beds, intubated and hooked up to every possible wire and tube you can think of. Drips, tube feedings, multiple IV pumps, vital signs, you name it. I thought, "Wow, poor guy." But something made me look further, I saw his name and realized it was my guy. My heart dropped to the floor, along with my jaw. I couldn't believe the last I heard he was home and doing better and now he was in the ICU, unconscious. I walked closer to his room and watched him, watched the ventilator breathing air into his lungs methodically for him. I couldn't believe it. And I knew, at that point, regardless of all evidence, even though I knew nothing about his current medical status, I knew- that he was facing death any day now. I could feel it in the room, it was as if he wasn't even there any more. His lively and kindred spirit wasn't there and that deadweight feeling was left in the room, daunting.


As for on my floor, I work on an oncology unit. That being said, I've had multiple patients in the past that simply couldn't pull through the advanced cancer. This knowledge has helped me develop pretty early on in a patients diagnosis on whether or not I think they will make it, and sadly......I have been right, lately. And that makes it so hard, staying with these patients for weeks, months, prolonging the inevitable. Watching them suffer slowly. When you know they probably won't pull through and yet the family has no idea. Sometimes even the patient doesn't have an idea....but most of the time they do, too.

 This same sense has proved to be intact with patients outside of oncology as well. Recently I had an 83 year old with advanced end stage COPD. I knew he wasn't going to make it til the end of the week. In fact, (and this was the first patient I ever did this for), I prepped him for a code blue on my shift. I made sure my IV was definitely intact, made sure the room had a lot of spce, made sure the code cart was handy, because I was that sure he was looking at the light.  He died that week.


I was just blessed enough to have about 8 days off from work, I went on vacation and had some free brain time, away from all the nursing and death and living. The only medicine I had to think about was my own, and I gave my cousin a bandaid and some neosporin. 

However, when I got home, the very first night I had to sleep, I had this awful- frighteningly lifelike dream. I was at work, and in the dream I was standing over a patient's bed. She was a young female, in her 40s. She was a mom, I knew that in my head in the dream. I also knew she had advanced cancer and she was going to die, soon. In the dream I was faced with the ultimate daunting task, the husband asked me, "Is she going to die? What do you think? I've heard what the doctors have said, but what do you say? When will it happen?"  No nurse ever wants to answer that question, ever. In the dream we were in an absolute white room, white floors,white walls, no furniture. I sat there in the dream checking her foley output, knowing how much it decreases before death. I held her hand and told him nonverbally what I thought, what he already knew.

What kind of dream is that? What happened to dreams about princes and frogs and fairytales? Seriously, but it just goes to show that a nurses mind never shuts out the world of medicine. Once you start developing that nursing spidey sense, it never shuts off, even if its in your dreams as well.

I love my nursing spidey sense. Like I said, its been handy when deciding what to do next with my patients and helps guiding long term thinking for your patient. But sometimes, I'd like to not be right about the death sense. :-\ Its a strange conundrum.



~WNB



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You've Got a Point

So I have this 93 year old gentleman, who is 100% "with it", aka he's still got it all up there. These are the patients I truly cherish as they are fascinating to talk to. The stories they can tell can blow you away and sometimes you feel like you're working with a truly honorable person, even for just making it this far in life. Anyone that climbs past 90 gets a special medal in my book.

Anyway, this poor gentleman had an NG tube in his nose, which travels down to the stomach. Patients may get these for different reasons, but in this case its purpose was to drain out contents that was impeding a potential small bowel obstruction.

Patients generally hate these tubes, as it is a tube that goes into a nose nostril, travels down the back of your throat. Patients hate it. I would, too. Everytime you swallow, a tube is there and you have to walk around with a tube coming out of nose, on top of totally feeling like crap.

So this one patients tube was giving me a little trouble and I was resultingly in there more working with it, which unfortunately causes him more discomfort. So this is how our conversation went during this whole ordeal:

Patient: "I don't like this tube, it's stuck in my throat."

Me: " mr patient I can imagine this is very uncomfortable and I am very sorry for that. I'm going to do the best I can to make it a little more comfortable for you."

Patient: "what you CAN do is take it out! That will make it all better."

Me: "I know that would make you feel less discomfort but Right now your doctor thinks its best to leave it in, at least for tonight."

Patient: "yeah, he's not the one with a tube down his nose!"


Me, thinking: "touché."



WNB.

Facepalm.

The past....couple days...week....month...have just been the type of days where I just want to be like......*facepalm*. Complete and utter failures, some on my part and some on other peoples parts.

It's hard to explain. It just seems that lately, no matter what direction I turn in, there is somebody there to point me in the other direction (in a not friendly way), or someone that is telling me I'm doing whatever I'm doing, wrong.

I hate confrontation. I'm beginning to really learn this about myself. I've always known growing up that I hate confrontation, but I'm just seeing now as I age into my mid twenties how much of a big problem it is. In high school and college, It was easier to let things go, let things slide. It was OK to get pushed over because the people that were primarily doing the pushing was my own parents, getting me to better myself more and more. But what else was there really to worry about? I had a part time job and that money went to funding things I enjoyed. No adult problems, I was well taken care of. So why strengthen the need to defend myself?

Until now. Hitting mid-twenties and living away from the parents, working a full time job. My friends are getting older with me, all with their own serious problems as well. They are getting married, having babies, being parents....life is rapidly changing around me. I am dating and this leads to really learning a LOT about the human race and how screwed up some people are out there.

All of those above unique scenarios lead to the inevitable set of confrontations. Two people are bound to come to a problem, and there needs to be a solution. Only two things can happen:  1) The two people can compromise.  2) One person has to completely back down.


Lately, I feel like I am doing nothing but continuously backing down. Not just for the same person, either- but in my job, in my living quarters, in my family, in my friendships, in the dating world. And its making me jaded. The more and more I witness the human race behaving like this the more I revert back to my original dream of wanting to live in a tiny cottage at the top of a mountain, alone.

I am the type of person that will do your side of your work for you, without being asked. Just because. I will go out of my way to help you and expect nothing in return. If I owe you money I will do my absolute best to pay you back as soon as I can. If you owe me money, I will never say anything. If I ask how your day is and you don't return the question, I'm still just as nice to you. I will pay for my friends/dates to eat or do whatever we are doing. I let my friends/dates pick whatever they want to do, what they want to eat.


Why, do you ask? Because I don't know how to be anything else. I literally don't know how to tell someone "you're being a JERK, and you are SO WRONG, why can't you SEE THAT?" Instead I keep it all bottled up. I guess part of it stems from being a nurse. We are trained to be able to keep a poker face when being in very awkward or difficult situations and to never talk back to a patient. So I guess I take that nature home with me.

A lot of me has always believed strongly in Karma. I think, "Okay- If I can handle this wrongdoing to me now, karma will bite them in the ass." Or, "maybe this person doesn't realize they are doing something wrong. Maybe next time they will realize and be extra sorry."

But it never happens that way. Karma never comes through. At least not in ways I can visibly see. People around me- acquaintances and people I consider friends, continuously make the same patterns and do it over and over.

And I get it. I do. If I never say something, then how are they supposed to know they are doing anything wrong? I guess I'm naive and immature in thinking that "Oh, eventually they will grow up and look back and realize they were wrong." But will they? Do people ever really change? No.

And lately I've been working on balancing out the wrongdoings. I make baby steps and confront people on the smaller issues but I have this inferiority complex and I instantly feel like a mouse asking for a cookie. A cookie that was never that persons cookie in the first place. Somehow I've either managed to surround myself with very dominant personalities or maybe I am just that introverted on the scale.

The only confrontation I know how to do is avoidance. And by avoidance, that means I won't seek you out for anything, even if you are the only person I know that can do me a particular favor. I will build my own damn house by myself before asking you for a hammer if I'm trying to avoid you. But I'm not even strong enough to tell you off or to even TELL you I'm upset once you do seek me out for whatever you need.

I let people walk all over me because I'd so much rather be the one thats hurt than worry about you being hurt, and I'm the one that hurt you. Is that so wrong? I know I can't let everyone walk all over me. I have to find a balance. But even when I attempt to fight back, it retaliates so much and backfires so drastically in my face, and things end up even worse than they were before. So I stop trying.


Lately it just seems like I've been dancing with the devil in many forms. You can't beat the devil. You have to get the F out of hell before he knows you are down there. And again, I leave hell thinking "boy, I really hope the devil meets his karma". But he won't. He's the devil. There is evil in this world and good. And I grew up thinking the good will always win. If you always do good for other people, people will do good to you. We always learned in elementary school to "treat others how you would like to be treated" and that motto always stuck in my head. But the devil will always be there, and he doesn't seem to give a flying shitwad if you treat him well, he's still going to screw you over.

Humanity makes me sad. Lately strangers make me happy because I don't expect them to be decent. Strangers can go either way, and it makes your day when a total stranger does something really nice for you. We live in a strange dark world and it brightens your day when a stranger smiles at you from across the room. Suddenly you don't feel as alone.


 I hope my faith in humanity comes back soon. I miss it.

I get that I am wrong here too in a lot of ways. I have disabled and very disorganized coping mechanisms. I get that. I need help with that. But part of me just wants to go build an igloo in Alaska, live there, and call it a day.



Sorry for the depressing mombojumbo post. I guess this is one of my few places I can let myself vent, even just a little bit.


~WNB.



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Well, that is true...

So when we do an admission assessment, we always have to ask the same questions for everyone. So much so in fact that it's easy to memorize. Regardless, there is one question that is in the beginning of the admission assessment that prompts the RN to ask the patient to describe in their own words why they feel they came to the hospital or why they got admitted. This is done to highlight the patients understanding of the plan of care and to document the initial symptoms the patient is experiencing so the admission story is easily referenced by all RNs taking care of that patient. So this is how it went down this morning:

NURSE coworker: "can you tell me what brought you into the hospital today?"


Patient: "umm........an ambulance...."


I almost died from holding the "kudos!!!" in. She WAS right...



:-) WNB

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