Ugh. This week has been a tough week for me. Right now I'm so exhausted and really don't want to go back to work tomorrow. Several factors are contributing to my feelings of dread. First, I'm on a long stretch of work days, which means at this point in the week, I'm pretty much tired of work. Second, the patient load this week has been overwhelming for me. My hospital treats some really sick patients, which in nursing lingo is "high acuity patients". Providing nursing care for medically complex patients is exhausting. I think it's double fold for a new grad nurse because we generally know enough to keep patients safe, but lack the expertise that comes with experience. There is a lot of literature published about the journey from new grad nurse to experienced/expert nurse. Patricia Benner is a nurse theorist who has researched and published a lot of information about the topic. It's funny because in nursing school I remember thinking to myself, yeah yeah yeah...nursing theory....blah blah blah. :) But there's truly something to Benner's theory. I'm at my 5 month mark of being a nurse and I feel like I know less now than I did when I started! (Which is apparently right on track according to Benner's theory). This week really highlighted this for me.
Monday admitted a patient who presented with shortness of breath (SOB...which still makes me giggle when I see it in charts). His SOB of was secondary to metastisis of cancer to the lungs. Usually when we see a patient admitted with an acute problem, such as shortness of breath, constipation or urinary retention, etc, we are immediately concerned with cancer metastisis (mets). So, my patient was sitting in the classic SOB position, tripod position, to maximize his ability to breath. The doctor had evaluated him, put in orders and was on his merry way. Leaving me to get the pt comfortable. Long story short, the patient couldn't do any type of activity without his oxygen saturation dropping into the low 80's (90-100% is normal and necessary for tissue perfusion). He was sitting in a chair next to the bed but could not lay in bed because he felt like he couldn't breathe. I tried to assess the situation as best I could and discovered that he truly couldn't take a deep breath and thus planned to spend the night in the chair. I paged the oncall doctor to communicate my concerns and ask if there was anything more that we could do for the patient. The MD proceeded to speak to me in a somewhat condescending tone saying that the team was doing all the appropriate measures and there was nothing more he would order for him. I truly felt helpless! This patient feels he can't breathe and after talking to the MD, I was suppose to tell him 'tough luck...there's nothing else we can do for you'. I wouldn't accept that answer so I called respiratory therapy (RT) and asked them to come and evaluate him. Sure enough, they had the same assessment that I did. They recommended a nebulizer treatment, which eventually provided some relief for the pt.
My point in this story is that I knew that there was something wrong with my patient and that we weren't doing enough to help him breathe, but I didn't know what suggestions to make to the MD in order to address my concerns. It turns out that many times, it is the nurse who makes suggestions to the MD about what might help in certain situations. As a new grad nurse, I don't have all the knowledge that I need to do that. But each day, I learn something new and try to store that knowledge somehwere for safe keeping until I need it at a later date. Over time, I'll move through Benner's stages and become an expert nurse who listens to her intutions and applies knowledge from other situations to help improve patient outcomes.
No comments:
Post a Comment