And your name is...???

Frequently when meeting someone for the first time the first thing a person does is introduce herself. I work at a teaching hospital where there are student nurses, medical students, residents and many more. This seems to be a big issue for them. They always forget to introduce their self every time they go into a patients room. Then when I go in the patient is asking me, "that one doctor, the tall one, with short brown hair?". Well...there was about three of them that were tall with short brown hair so I really don't know which one it was. I got into this discuss with one of our ortho residents that I am friends with a few nights ago. I called him  at the beginning of the shift to get an order for Norco for a patient that was in a lot of pain. When I pick up the phone on my unit I always answer by saying, "Davis 14 this is Norah speaking". The resident on the other end replied saying, "hi this is ortho". So my response to him was, "who am I speaking with ?" and he replied saying, "its ortho" and again I asked for a name and he finally told me his name. He sounded rushed and busy to I acknowledged that it sounded like he was in the middle of doing something and but that I needed an order for Norco as my patient was in 10/10 pain and was maxed out on all other pain medications. Before I could even finish telling him exactly what I needed he said "ok norco got it im putting it in" and hangs up. Sure enough the order pops up on the computer but its wrong. So now I am just annoyed because just as busy as he was so was I and now that was one more thing I would have to worry about having to call him back later on that night to get the order corrected not to mention my patient was going to be upset when I was only giving her one tablet and the incorrect dose than what she usually takes at home. So my luck, later on that night I was on my break and I ran into the ortho resident I spoke with and he sat down to chit chat with me. Because we are friends I asked him what was up with him earlier on the phone and why he doesn't know how to introduce him self when he responds to a page. His response was "I don't have time". What? You don't have time to add in your phrase "hi this is ortho ___ is speaking"? That is a ridiculous excuse and I told him that. I told him his name was not "ortho". He laughed and I told him I was serious. I told him that as a nurse when residents don't say their name on the phone when returning a page to me I just take it as they don't want to be identified so that if they are acting like jerks they can't be identified and approached later on for their behavior. Personally I have nothing against our residents. I have a lot of respect for all their hard work and getting to where they are. BUT sometimes they forget what the job is exactly that they signed up for. Part of their job is to answer calls in the middle of the night. That is how it goes. It doesn't matter how busy they are in the ER. Calls still need to be returned. If it is truly THAT busy then residents need to learn to call their chief resident and have them come in to help. That is why you have a chief, for back up. As a nurse we understand what busy is. We have 4 to 5 people expecting ONE person to be available for 12 hours every second of the night at any moment. Unrealistic. I physically cannot be in 5 places at one time. So if I am stuck in another patients room and I know I won't be leaving for a least another 10-20 minutes because I am in the middle of doing something and I am getting paged by another patient that is when I have to call for help. Ask one of my colleagues to check on my other patient and see what they need. Let them know I am not ignoring them but with another patient at this time. The same concept applies to the residents. Use your resources. There is no excuse for not introducing yourself especially when your asked to state your name. It goes back to being professionals. If you want to be treated like a professional you need to conduct yourself like a professional. That is all.

Until next time.

-Norah

Professionalism

Professionalism. So much goes into being a "professional". Not just in nursing but in every work environment. I'm prompted to write something about this because a couple of days ago it was the end of my 12 hour shift and I had  gave report on all of my patients except for one. I was looking for the day shift nurse in charging of caring for that patient to give report however, she was nowhere to be found. Therefore, I went to the day shift manager and asked if I could give her report because the staff nurse was not there. The response I received was, "no, you still have a few minutes she should be here soon". The response is not what I was expecting but if we look at it technically it was about 7:10 in the morning. "Technically" my shift ends at 7:15 am. So yes, "technically" I could wait around for another 5 minutes and hope the staff nurse shows up. However, I felt that it was an unprofessional situation as the staff nurse that was not there should have been on the floor by 6:45 am. If she was on time to work I would have been leaving on time from work. Needless to say, she was almost a half hour late to work by 7:10. So I had to pay for her unprofessionalism because I ended up leaving the hospital at about 7:35 am that morning. Why? Because the day shift manager didn't recognize that I should be LEAVING at 7:15 am not waiting until 7:15 am for a staff nurse that was running 30 minutes late and then stay late to give her report to her AT 7:15 am. Now, I really don't care about leaving at 7:35 am but it's the principle. I had to pay for someone else's unprofessionalism. When the right thing to have been done was the day shift manager take report for the day shift nurse and let me leave on time and not make me assume responsibility for someone else's unprofessionalism. But, in the "professional" world you learn to pick your battles and this one wasn't worth it to me.

A battle that is worth my breath again comes back to professionalism. Now, my floor has private rooms and semi private rooms. We are a primary nursing facility which means there are no nursing aids or assistants. The RN does everything for all 4 or 5 patients. We all know there are intercoms in the room so you can ask the patient what they need without going into the room. This is great if it's a PRIVATE room. However, semi private, NOT ok between the hours of 10 pm and 6 am. I personally never answer my patients from  the intercom whether its private and certainly not if its semi private. Why?? Because in semi private rooms there is only a curtain separating the two patients. I don't appreciate and especially my patient that is trying to get some rest doesn't appreciate the other patient who constantly needs to be readjusted or needs pain meds to wake him/her up by calling the nurse every 20 minutes and the nurse shouting over the intercom, "hi Mr. Doe how can I help you". Could you

imagine if you were in the other bed trying to sleep?! You would not be happy. I have a few coworkers that have done that and I've had to approach them and ask them in a professional manner to please stop using the intercom in the middle of the night because my patient was frustrated and could not sleep. Again, this boils back down to professionalism. Being professional in this situation means being considerate that there are other people in the room not just your patient you are answering on the intercom. It would be much more effective to slip into the room quietly and ask Mr. Doe what he needs in person quietly. I am sure Mr. Doe would be happy with that service and sure as hell his roomie would be too. 

As nurses sometimes we forget that our patients are our customers. That is why we are there. For them. Not for our convenience. It is these things that make patients give high satisfaction scores for a hospital. It's courtesy over efficiency. Figure out how to be courteous and efficient at the same damn time. Your patients, their roommates, family members etc will love you for it. You are a professional so act like one. It's just like when you go into a store lets use home depot for example. You walk into Home Depot and you are looking for a certain type of screw. Now you know Home Depot has a whole entire isle dedicated to screws and this is not stuff you are really familiar with so you ask an employee for help. The first employee tells you where you can find the screw and points you in the right direction. So you go and you look and you still can't find the damn screw you need. So you ask another employee. THAT employee stops whatever she is doing and not only tells you where the screw is but WALKS you over and SHOWS you exactly where the screw is so your not wasting your time looking around. That is being professional. The second employee recognized you as a customer is more important that whatever the task at hand was and stopped everything to help you. Intern, you are happy with your service and next time you go to Home Depot you wouldn't hesitate to ask that same employee for help because you know they will actually be helpful!

It's not rocket science. Nursing is customer service just like anything else. Your patients are your customers. Being in a hospital that is trying to get magnet certified it is so imperative that all the nurses understand this. Courtesy above efficiency is how you become a magnet hospital. Being a professional is part of being courteous to your patients as well as your coworkers and all other staff and family members. Anyways, I've rambled on too long on this subject.

Moral of the story if you want to be treated like a professional act like a professional.

Until Next Time.

-Norah

Burn Nurses

This is for all the burn nurses out there. Let me just say I am so thankful people like you guys exist! Because my floor takes burn pts but generally they are step down icu burn pts. We still do dressing changes and everything but rarely have to do the debridement. Phew!! I can't handle debridement. Especially when it's the initial one. Popping the blisters and taking the skin off. Not for me. Honestly, HUGE props to you guys. It takes someone with a really big heart and an even bigger stomach to handle some of the things you nurses see. When I first started caring for burn pts it was so hard. Even to look at them. And then the dressing changes and the pain... It seemed like all the fentanyl and dilaudid jn the world wouldn't be enough. It was so hard to just do my job. To see someone in that much pain...broke and still breaks my heart. But it got easier over time to handle until I got my first 95% burn pt. A 22 yr old girl who was a victim of a fire. My heart and every piece of me went out to her. I was her primary nurse for over 6 months. Man...I think about her until today. I remember her telling me she couldn't wait to wear heels again. I recently had surgery on my knee and couldn't wear heels for 4 months. I couldn't wait to wear them again and I always thought of her. Because I knew and she knew wearing heels was no where near feasible for a long time but a very important goal for her to accomplish eventually. At that point she could barely stand for 30 seconds with sneakers on. We always had "girl talk" and it made me sad because she would never look the same again. She had pictures all over her room of what she looked like before. she would refer to herself has a monster and it would make me so upset when she would! I spent hours building her up as I'm sure all you amazing burn nurses do on a daily basis. She was one of those patients that was very time consuming emotionally and physically but I didn't have the heart to say I didn't want to take care of her when I was on because other nurses neglected her and that made me so upset! So I just didn't care anymore about how much "work" she was. It made me happy to know she was happy the 3 nights I was on to take care of her each week. I just wanted her to not have to worry about her care on top of everything else that had flipped upside down in her life with her injuries.  

Burn patients are something else. Nothing compares. The fact that you have to inflict pain for them to get better is crazy. The surgeries....surgery on surgery on surgery. Grafts, donor sites, releases and all the rest. That's just the medical part. That doesn't even include the body image issues, depression, and altered functional status. I have so much respect for all the nurses that choose to be burn nurses. You guys are truly amazing. It's definitely not my top pick in the nursing world. But I know it can be rewarding especially for those patients that really tug at your heart strings. The ones that make u want to turn the sky pink if you could if it meant they got better...keep doing what you do. Hats off to y'all. 

Until next time.

-Norah

Stand out continued...

A few days ago I wrote a post titled, "stand out". I just wanted to briefly add to that post. I am reading this really good book that anyone interested in healthcare management should read. It's called, " If Disney Ran Your Hospital 9 1/2 Things You Would Do Differently" by Fred Lee. He says something interesting in the since that we as nurses tend to compare ourselves to other nurses to gauge our excellence. However, in his book he suggests that really our "excellence" is gauged by our patients by not just comparing us to other nurses but to anyone that provides services to people. So essentially the patients are making their assumption on how "excellent" of a nurse you are based on the standards set by the nicest people giving services anywhere. Whomever they may be. It makes complete sense. I compare my waiters/waitresses to nursing and customer service all the time. When the waiters/waitresses are probably just comparing themselves to other waiters and waitresses when really they should be comparing themselves to anyone that provides customer service to anyone in any fashion. That's all. Something to think about when at work to be that stand out nurse. 

Until next time.

-Norah

Be Responsible

One of the committee's I am a part of on my unit meets once a month and discusses issues that come up on our floor and we brain storm ways to improve them. We also talk about magnet stuff, patient satisfaction scores and all the other stuff like falls, CAUDI, CLAPSI, and VAP scores. At the end of the 2 hour meeting we have what we call "round table" where we go around the table and it's basically an open floor for the reps to bring up any issues that were not on the agenda that we want to address. A reoccurring theme is nurses complaining about things like other nurses not putting out vitals machines from their patients rooms for the next shift, not placing the bar coders out of rooms before the next shift, not keeping their patients rooms clean and tidy, nurses giving attitude to their colleagues when they ask them for help, and nurses not prioritizing well and dragging everyone else down. These problems to me personally cannot not be fixed by management or anyone really. These types of problems are individual issues that each nurse needs to take responsibility for her own actions. Management nor your coworkers need to be NOR want to be your mother. It should be part of your practice when you are done with your vitals machine put it out in the hallway and pull it in to charge. When you are done passing your meds and scanning your pts place that bar coder back on the charger. Clean and tidy your pts rooms when you are in there every night. It shouldn't be messy if you keep it tidy from the start. If you have a personal issue with another nurse giving you attitude approach that nurse NICELY and say something like, "Hey Suzie, I am not sure if you were really stressed last night but it seems like you were upset with me last night when I called to ask you to help me pull my patient up in bed. Is there anything you want to talk to me about?" Most of the time Suzie will come up with a reason why she reacted that way she did. Give Suzie the benefit of the doubt. Maybe SHE WAS stressed because she had a heavy assignment that night and you didn't realize. Maybe Suzie didn't even realize her tone of voice came off that way. Don't take things so personal. It will make your personal life and work life much easier. We have a stressful job as it is. Don't add unnecessary stress voluntarily. Also, as nurses we often feel like if we dont do all the work ourself we are "bad nurses". That is NOT true. If you are drowning, ask for help! Learn how to delegate. Often times your coworkers are not as busy as you are and are more than willing to help take a set of vitals or pass meds for you if you are drowning. This is another source of animosity between nurses. When one nurse feels like she is drowning but does not ask for help and her coworkers are sitting in front of the computer looking at facebook or pinterest and are supposed to just magically know she is drowning and needs help. You cannot be mad at your coworkers if you never even gave them the chance to help you. So ask for help!! Ultimately, we are all grown adults working a professional job. Take responsiblility for your actions and act like an adult because are you are one. I don't like to feel like I am the oldest nurse around when in fact I am the youngest of my colleagues. Nursing is stressful. But if we work as a team and stop the blame game it would be THAT much less stressful. So next time you go to work. Be positive, smile, and if you have some down time ask if someone else needs help. Your work environment will drastically change and you will be much happier. A happy nurse = happy patients. Corny, I know :).

Until next time.

-Norah

Stand out!

 

Every nurse needs one of these once in a while to remind her/him that they truly make a difference in peoples lives every day they are on the job. Sometimes it feels like we aren't because nursing can be very demanding not just from out patients physically and emotionally but, sometimes it's management, poor staffing, or simply just a poorly run hospital all together. Regardless, it's important to remember that we has a job that effects peoples lives and their families. Our care can be the difference whether that patient goes home or goes to a SNF. Be the nurse that stands out. Go the extra mile. Because at the end of the day it's not about how great we put in that IV or foley. It's about the little things. Patients don't remember things like a really good blood draw or IV start but they do remember when you went out of your way to find them jello when there was none on your floor or getting extra blankets and pillows for a family member or just putting baby powder on them after cleaning them up to make them smell fresh and feel dry. They really do appreciate these things and remember them. You will stand out if you do. A lot of nurses are busy and use this as their excuse as to why they didn't take the extra minute to go the extra mile. But the reality is, we are all busy. It's really about your passion for your profession. If you love helping people and taking care of them you will go the extra mile even for the ones that drive you absolutely nuts. I personally find that when I give my patients a little extra TLC they don't call as much and are not so needy because I already anticipated all their needs and also made sure to ask if they needed anything before I left the room. Now I know what your thinking. What about the patients that you do ask if they need anything and they say no but the moment you walk out you are called back in for something. This is when you politely tell your patient you have no problem getting them whatever they need and tell them honestly for example if the patient is asking for crackers but you need to give pain meds to another patient. Clearly the pain meds are your priority. So don't be afraid to tell your patient and be honest say something like,  "Mr. Doe ill be back in about 15 minutes with those crackers because I've got another patient that is in pain that I need to give pain meds to first. Is there anything else I can get you when I come back with your crackers?" Mr. Doe is usually very understanding and is happy that you told him it will be 15 minutes before he gets his crackers so he's not sitting in his room thinking you just forgot to bring him his crackers and starts paging you again while you are trying to pass your pain meds. A lot of times I have found those patients that noone want to take care of and are rude and grumpy all the time are the ones that have been in the hospital a long time. What I mean by a long time is at least a few months. The ones that come in for sepsis and end up in and out of the icu with complications. They usually need a lot of help, have a lot of meds, are very busy. Over time the patient wants to go home is tired of the nurses living them in a dirty bed, not paying attention to their needs, not making them feel like they actually care about them, the doctors are making the patient feel like she should just give up and be a DNR. These patients if the nurse just takes sometime reassures that patient I am here to help you get better actually LISTENS to the patient and doesn't argue. USUALLY the nurse can win this "grinch" of a patient over. I speak from experience. Try it. You need a lot of patience. This is not a power contest. We are in this profession to help people. Don't lose site of that. You can make your job are rewarding as you want it to be. So go the extra mile and be the nurse that stands out.

Until next time.

-Norah