TAKING CARE OF PATIENTS on your own for the first time can be daunting. Working as a new nurse in a CCU, caring for patients who are balanced on the bubble between life and death can be downright terrifying. But with each hour that passes, as your patient maintains a patent airway, stable cardiac rate and rhythm and BP, and adequate urine output, your confidence begins to grow.
Until something goes wrong, of course. Maybe your patient goes into atrial fibrillation with a rapid ventricular response. Maybe his or her systolic BP drops into the 70s. Maybe a more experienced nurse steps in and points out something obvious that you missed, simply because you're still learning.
What can I offer?
Having been a nurse for just 7 months, I face issues like these each time I start my shift in the ICU. Many of my colleagues have been nurses for 20 or 30 years, and they often make patient care look easy. Dealing with issues ranging from time management to cardiac arrest are second nature to them.
In the midst of all the knowledge and expertise of my seasoned colleagues, I sometimes wonder: What can I do for a patient that'll make a difference when I'm so inexperienced?
Sound the alarm
These were the thoughts running through my head one chilly October evening as I arrived for my 12-hour shift. I breathed a sigh of relief after getting my assignments: two patients who were currently stable. One patient, Mr. H, had undergone minimally invasive thoracic surgery for a lung tumor and was expected to be discharged within a few days. This sounded like something I could handle.
The nurse who gave me shift report warned me that Mr. H was easily irritated and didn't follow instructions to ring his call light for help before trying to get out of bed. His bed-exit and chair-exit alarms had been ringing all day.
Mr. H was sitting up in a chair when I went in to meet him. He seemed pleasant. We made small talk while I completed his physical assessment. After making sure his chair-exit alarm was connected, I told him I'd be back in a little bit, and to push his call light if he needed anything.
Just as I sat down to document, I heard the woodle-whoop of Mr. H's chair-exit alarm going off. I hurried into his room and found him tottering toward the bathroom. After giving him a gentle reprimand for not using his call light, I helped him to the bathroom and then back to bed.
I asked Mr. H why he didn't use the call light to get help. "I don't need any help to walk," he said, "and I didn't want to bother you."
I sat down and he started to talk. A very independent person, Mr. H had worked all his life and was used to not only doing things for himself, but also taking care of others. And now, being in a strange environment and having to depend on other people was making him feel, as he put it, "like a caged animal."
Mr. H and I talked a few more minutes, and I reassured him that everything we were doing, and all the monitors he was hooked up to, were only for his safety. I asked him again to please use his call light when he needed to get up. He said, "I'll do it, but only for you." That was good enough for me.
Stop and listen
After fluffing Mr. H's pillows and making sure he was comfortable, I turned to walk out of his room. Suddenly, he reached over the bed rail and grabbed my arm.
"You've done more for me than anybody else since I've been here," he said.
I was completely caught off guard. What had I done? I hadn't given him any medications or changed any dressings or bathed him. I certainly hadn't performed any lifesaving feats. All I'd done was listen to him and fluff his pillows.
And then I realized that taking care of patients doesn't always mean having the most skill or the most knowledge. Whether you've been a nurse for 20 years or 2 months, sometimes the best thing you can do for your patient is to stop and listen. And don't forget to fluff the pillows.