On The Clock

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Before I move on to the fourth (and final) installation of my rantings observations on my stay in the hospital, I’d like to take a minute to introduce you to the blog’s newest sponsor! I am thrilled to welcome nursinguniforms.net to the blog, and want to thank them for their interest in the blog! Please peruse the site if you get the chance!

The final observation I’m going to make (for now) is on nutrition services. And before you jump to conclusions, this isn’t an “I hate hospital food” diatribe, I promise!

I found that the cheeriest, happiest, most obliging staff that I encountered were the nutrition staff. Every time they brought a meal, they had smiles on their faces, laughed, called me “sweetheart,” and wanted to make sure I didn’t need anything else. I didn’t actually get breakfast the first morning I was admitted, and when the lady came to take my tray, she asked if someone had already taken it. I said “Oh, no, I didn’t get anything to eat.” She looked shocked and rushed off to find me a tray. She wouldn’t stop apologizing, and I kept telling her not to worry, that I was really okay!

They always seemed so worried that I was going to be disturbed by their presence, and while I never was, it was sweet to know that they were worried about bothering me. They’d always say “I’m so sorry to bother you, but are you finished with your tray?” If I were sleeping or trying to rest, they would quietly come in and take it without waking me, and they were the only ones who made a point to try not to wake me up.

My only complaint was that although I was on a full, unrestricted diet, and should have gotten to choose my meals from a set menu, I never did. I don’t know whose responsibility that was, but I kept wishing that I had gotten to choose chicken instead of pork, or tea instead of coffee. I know that I could have asked the nutrition staff if I could get something else, but because they were so nice I actually was concerned about bothering them! Don’t get me wrong; I’m not a hugely picky eater, and would eat the majority of whatever they served, but it would have been nice to choose.

And yes, the food wasn’t stellar; I wouldn’t choose to eat that food again, but to be honest it could have been a lot worse. I was actually in the hospital for Thanksgiving, and they brought up a turkey dinner with mashed potatoes, carrots, cranberry sauce, and stuffing. It wasn’t the best Thanksgiving feast I’ve ever had, but it made me smile. They had made the effort to give those of us who were sick and in the hospital on a day we should be with our families a little bit of comfort and tradition, and that was all I could really ask for.

So to everyone who works behind the scenes in patient care…whether you’re working in nutrition, environmental services, registration, maintenance, or housekeeping…thank you for what you do. Giving me a Thanksgiving meal, leaving a flower in my room after cleaning it, and trying not to disturb me while I was resting are all small things, but they did not go unnoticed, and they will be remembered.

I suppose that the moral of this story is that…things don’t always go as planned in the medical field. Not every patient is treated the “textbook way” by the doctors or nurses, and there is certainly no rest for the weary as an inpatient. But I can certainly say that the things I have experienced during my time in the hospital will make me a better provider. I know that years from now I may become tired, a bit cynical, and maybe even jaded or burnt out; but I do hope that I can remember what it feels like to be a scared, anxious patient who only wants some answers, some rest, and to go home to her own bed.

As always, thoughts from your perspective as a patient or provider would be much appreciated! Thanks for reading and keeping up with this whole series, and I can’t wait to hear your feedback!

Stay safe out there,
Sam

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Alright, after a brief hiatus so that I can focus on my final exams, we’re back at it! Here is my third observation from my recent hospitalization after surgery. If you missed them, you can read part 1 here and part 2 here. So, let’s get back to it.

3) Physical Assessment?
In nursing school this semester, we devoted an entire unit to the physical assessment. We learned what a full assessment entailed, we had to learn how to perform each individual part of the assessment from head to toe (along why it is done), and we even had to do one on a partner and be evaluated by our teachers. We were told in no uncertain terms that “a full physical assessment is done on every patient who is admitted to the hospital, regardless of the reason for admission.”

While I was in the hospital, yes, I was assessed. After shift-change happened, a nurse would come in, listen to my heart and lungs, and a CNA would get my vital signs. Once, a nurse listened to my bowel sounds. But never was I asked the questions to check on my level of orientation (Do you know what day it is, do you know where you are, do you know what happened to you, etc.). No one ever shined a light in my eyes to see if my pupils were equal, round, and reactive to light. My stomach was never palpated, my skin was never assessed, and no one ever measured the angle of my nail beds (hah!).

I understand that the physical assessment is not always applicable. I was awake, alert, and had appropriate responses, so of course the nurse could check a few things off right off the bat without having to walk through them step by step. Other things, such as measuring the angle of my nail beds, were excessive. I had no difficulty breathing, I am not a smoker, and I have no history of any major respiratory illnesses aside from some minor asthma. So, clearly, there’s no reason to suspect clubbing of my nails, as I have relatively normal lung function.

I want to point out that this is not a criticism of the nursing staff, it’s simply something I noticed. I’ve been hospitalized before, and noticed different things around this. For instance, when I was admitted for a concussion following a bad car accident, I was neurologically assessed every shift, but that was not the case when I had appendicitis or had my parathyroid removed. Another thing I found was that when I was admitted from the emergency room, rather than from surgery, I did get a full assessment. From the ER, I went to a pre-admit holding area where they did the full assessment. They asked about my religious preferences, dietary preferences, inspected my skin, looked in my eyes, etc. They provided a baseline assessment for the floor nurses to refer back to, but when coming from the operating room, this was never done.

Again, I’m not trying to say that this is something where the nursing staff failed me or anything like that. It’s just that as a nursing student, and having had an entire unit devoted to the physical assessment, I find it interesting to see that as a patient I only ever experienced a partial or cursory assessment during this admission.

What about you? If you’ve ever been admitted, do you remember the assessments that were done on you by the nursing staff? Nurses, on which ward do you work, and do you always do a full assessment on every patient? What criteria make you do a partial assessment versus a full one? I’m truly interested in learning more about this, as hopefully I’ll soon be doing this on a regular basis! Can’t wait to hear your feedback!

Stay safe out there,
Sam

Alright, moving right along, I bring you the second installment of my observations as a patient on the general medical floor of my local hospital! If you missed the first post, you can read it here.

2) Judgment.
During the chapter on Pain Management in nursing school, it was repeatedly beat into our heads mentioned that pain is whatever the patient says it is. If you ask them to rate pain from 0-10 and they say it’s a 9, then it’s a 9. If they say they are in extreme pain even though they are laughing and have no signs of pain showing on their face, then they are in extreme pain. As the nurse, we have been taught that we treat the pain that the patient reports.

Now, I have worked in the ER and on the ambulance and seen patients say they are experiencing “the worst pain of my life” while texting on their phones or filing their nails. I know it’s difficult to hear what they say and make it mesh with what we observe, but when I start to get frustrated I try to take a step back and remind myself of a few things. I am not feeling what they are, I have no knowledge of what their experience with pain is, and I usually have little-to-no clue what their cultural background is like. Once I can bring these things to the forefront of my mind, I come back to the situation refreshed and ready to treat my patient the way I was trained.

But this was not always my experience during my admission. I had some nurses (such as the nurse in the PACU) who charted what I said for pain, and got me the medicine that was ordered without question. They would try to figure out the best schedule for medicine, the best way to position me, how to adjust my bed, if food or drink would help me in any way, and other ways of helping to ease my pain. The nurses on third (overnight) shift were the best as far as pain control went. Maybe it’s because they weren’t as busy because other patients were sleeping, or maybe it was something else, but when I said I was in pain, they did everything they could to help me.

I had other nurses, though, who seemed frustrated, skeptical, or annoyed whenever I would ask for pain medicine. They’d say things like “you just had your pain medicine two hours ago,” (even though my medicine was ordered for every two hours) or “is it really that bad?” I’d be reminded that “it is normal to have pain after surgery, you know,” or “overuse of narcotics can lead to dependency.” So whenever I had these nurses, I would get so embarrassed to push the call button because I didn’t want to hear the judgmental words or see the eye rolling. I decided it was better to put up with the pain than have to deal with their comments. But as a future nurse, I can say that what I experienced is not the kind of environment I want for my patients. I am sure that some of these nurses have seen many drug-seekers, narcotic-dependent patients and “frequent fliers” who may have changed their perception of pain management, and I understand that. However, it does not change the fact that their preconceived notions about my pain led to embarrassment and shame on my part.

What about you? Have you ever felt judged as a patient when you request medicine, or get a prescription filled at the pharmacy? Alternatively, providers, have you ever caught yourself judging a patient for one reason or another? I’d definitely love some more input on this and maybe we can get a good discussion going!

Stay safe out there,
Sam

Over Thanksgiving this year, I had the unfortunate experience of having emergency surgery and spending two nights in the hospital. On Tuesday night, I called my doctor about some complications I was having from a surgery I had had two months prior, and when I went to see him Wednesday afternoon he asked, “when’s the last time you had something to eat or drink.” My heart sank, as I knew this was the “surgery question.” In one fell swoop, I had gone from thinking he’d give me a some medicine or tell me I was fine to having unexpected surgery the day before Thanksgiving. I wasn’t a happy camper.

So, I headed over to the hospital with my mom and saw some familiar faces. Not only had I been there for surgery related to this two months prior, but exactly one week earlier I had been there to have my tonsils out. I was so frustrated to be there that I had tears in my eyes, but the nurses were so reassuring and joked along with me about knowing exactly where to start my IV and things like that. It was really calming to be around smiling nurses who knew I was scared and did their best to put my fears to rest.

They took me to the pre-op holding area, gave me some Versed, and I got to speak to my doctor. The surgery was simple, he said, they just needed to drain an abscess that had formed at the surgical site and I’d be home for a late dinner. He patted my leg and said, “you’re going to feel so much better when you wake up.”

But I didn’t. No, not only did I not feel better, I felt much worse. I’ve been through surgeries before, and I know what is normal post-op pain. Hell, less than 24 hours after the original surgery two months before, I was off pain meds, upright, and I was at my first nursing school clinical. So yes, I know what it feels like to have pain from surgery, and I knew that something wasn’t right. The nurse in the PACU (post anesthetic care unit) was one of the kindest nurses I have ever met. When she asked me to rate my pain, she took me seriously and would say “okay, let me get some more medicine.” When I started itching all over from the medicine, she didn’t brush it off; she checked me all over for any signs of a rash or hives, and called the doctor to get an order for Benadryl.

Because I had had surgery so late in the afternoon, they transferred me to the general medical floor to finish recovering once the PACU closed. I was left in the care of the floor nurses, and everyone still seemed confident I’d be going home that night. It gets a little hazy from here on, because the Benadryl made me really sleepy. All I know is that I woke up at midnight still in the hospital, because my pain was uncontrollable.

Now, I’m not telling you this story just to update you on the goings-on of my life, this post actually has a purpose (I swear). During the time I spent in the hospital, I had some eye-opening experiences that I hope will help me during my time in nursing school and once I head out to work in the field myself. So, without further ado, here is my list of reasons that (in the words of a very wise friend) “the hospital is no place for a sick person.”

[Note: This started out as a small list of "things I learned from being a patient" but quickly developed into a several-thousand-word diatribe. For this reason, I've decided to break this into several posts over a few days so as not to write a totally overwhelming post!]

1) Sleeplessness.
What’s that thing you always say to sick people? “Get some rest,” or something, right? Yeah, that’s what they all said to me, too, and I would have been happy to get some rest had that been at all possible. To start, narcotic pain meds don’t make me sleep. They make me irritable, nauseated, and totally restless. So when I woke up at midnight, I literally only got five more hours of sleep over the next 36 hours, even though I spent each of them in bed.

The next morning, I asked the nurses if when the on-call doctor came we could see about getting me a sleeping pill due to the fact that the meds were messing up my sleep. They said sure, but that never happened, even when I asked the doctor myself. I was prescribed Zofran for my nausea, and I went so far as to ask the doc if I could have Phenergan since it tends to help me sleep. Inexplicably, she said no and I was continued on Zofran. That was problem #1, as far as my sleepless nights were concerned: no one was worried about my insomnia other than me.

Problem #2 was far more frustrating. On my second night in the hospital, I was up until 0500 but finally felt like I might be able to fall asleep. I closed my eyes, and drifted off until there was a knock at the door. I checked the clock and saw that it was only 0600. Rather than narrate the rest of the morning, let me list the times and reasons people entered my room:
0600: Time for my antibiotic
0630: Time for vital signs
0700: Shift change, RN and CNA introduced themselves
0730: Nutrition came to drop off my breakfast
0745: CNA wanted to let me know my breakfast was there, and asked if I needed help eating it.
0800: Time for pain medicine
0815: CNA wanted to help bathe me/do bed change. (By this time, I had stopped trying to sleep)
0830: Doctor came to do rounds
0900: Nutrition came to take my tray away
0930: Vital signs
1000: Pain medicine
1030: CNA wanted to know if I needed anything
1100: Discharge instructions

That’s thirteen times that someone entered my room in five hours. I was so frustrated; I wanted to say to them “listen, can you please, please, PLEASE just leave me alone to get some sleep!? I promise I’ll push the call button if I need you.” I understand that some things have to be done on a schedule. Vital signs, medicines, rounding etc. are all things that they don’t have much control over, and I get that. But things like the bath, bed change, welfare check, etc. could have waited, especially since I expressed to both the RN and CNA that I was exhausted due to not sleeping normally during my admission.

I honestly believe that had I been able to get some real sleep I would have been able to leave the hospital much sooner.

Stay tuned (I know you’re absolutely riveted!); tomorrow I’ll continue the list! And as always, I’d be thrilled to hear your input as a provider, patient, or third party on any of the points!

Stay safe out there,
Sam