an affair on trust
Sometimes it's really handy to have a blog. I can channel all of my frustration into words that don't particularly harm anyone. Yet I still get to express my opinion.
Yesterday at work, I had a total of 5 patients (at different times) because my assignment kept changing. I started out with 3, one notable for being exceptionally inquisitive and likely suspicious, who needed lots of reassurance that we knew what we were doing (as achieved by explaining what we were doing and why. although I'm not entirely sure that's why she was actually inquisitive, because some of her questions didn't really reflect on us. For example, she wanted to know why her liquid tylenol was measured in milligrams if it was a liquid; shouldn't it then be measured in milliliters? [the answer: concentration. mLs can easily change according to how much liquid you add. mgs don't.])
Midway through the morning, I swapped this patient for one of my co-worker's patients because he (patient) no longer trusted her (nurse). The reason for this was superficial, and I was actually on her side, but didn't overtly let him know that so that the rest of the day would go smoothly.
False hope.
Okay, "smoother".
Right after I inherited him, an emergency meeting involving the grandfather boss (the one above my immediate boss), the primary team (surgeon, fellow, and physician's assistant), me, and the patient and his wife took place in his (the patient's) room. The patient and his wife were very upset that we were not following the directions of one of his primary doctors [who does NOT work at our hospital, and thus does NOT have authority over us], repeatedly stating that it was just "common sense" to follow the orders of the doctor that is well trusted.
Sounds legit, right?
It's not.
Location, location, location. It's important in the medical field, too.
His favorite doctor, who I shall name Dr A for convenience of alphabet primacy, is an expert in a particular field. The point in question was about something else. Not in his field of expertise. So my co-worker had told the patient et al that he could take the medicines Dr A had prescribed (and which our corresponding doctors agreed with), but in the way that we recommended. Because based on our tests, if he didn't take the pills in the way sanctioned by our swallow pathologists [that's not a real department. I just called it that for explanation purposes.], the liquids would go in his lungs.
This is where the trust issue came in. The wife was more or less offended that we didn't trust the directions of Dr A. We were frustrated that she was trusting Dr A over experts in the field relevant to the problem. She was irritated that the nurse before me couldn't follow directions from said Dr. I was irritated that she thought all nurses did was follow directions.
Quick lesson here: NURSING JUDGMENT MATTERS. Did you know that if a lawsuit is brought up about a doctor's medical practice, a nurse will also be in the case and will be questioned for following a doctor's orders if that order goes against something the nurse "can be proven" to be obligated to know? I did not go to school, nor do I get paid, to follow orders. [if that's how nursing worked, man, am I in the wrong career. I hate being told what to do]. I get paid to THINK. And I went to school to know what to think about. The doctors call the shots, but nurses are supposed to stop the bullets that are going in the wrong direction. That is not to say I know more than the doctors, because I don't. I'm just supposed to be as smart as the doctors, to think as critically as the doctors. With less diagnostic and treatment knowledge, that usually means I'm just asking the doctor to explain the reasoning behind the order. Sometimes I learn something. Sometimes the doctor learns something. Because there is something nurses should know more than doctors: the day-by-day (more appropriately, hour-by-hour) state of the patient. How the patient is doing affects how the treatment will go down.
The object of our reluctance to follow Dr A's directions was not born from ornery insubordination, but from critical consideration. The object was to protect his lungs. First and foremost. Not to cover our butts, as was claimed (smart, but not true).
The result of the meeting was a stalemate, because we had lost a very important part of the patient-doctor relationship of trust, ironically because of an excess of trust for another.
I felt like they had cheated on me.
Yesterday at work, I had a total of 5 patients (at different times) because my assignment kept changing. I started out with 3, one notable for being exceptionally inquisitive and likely suspicious, who needed lots of reassurance that we knew what we were doing (as achieved by explaining what we were doing and why. although I'm not entirely sure that's why she was actually inquisitive, because some of her questions didn't really reflect on us. For example, she wanted to know why her liquid tylenol was measured in milligrams if it was a liquid; shouldn't it then be measured in milliliters? [the answer: concentration. mLs can easily change according to how much liquid you add. mgs don't.])
Midway through the morning, I swapped this patient for one of my co-worker's patients because he (patient) no longer trusted her (nurse). The reason for this was superficial, and I was actually on her side, but didn't overtly let him know that so that the rest of the day would go smoothly.
False hope.
Okay, "smoother".
Right after I inherited him, an emergency meeting involving the grandfather boss (the one above my immediate boss), the primary team (surgeon, fellow, and physician's assistant), me, and the patient and his wife took place in his (the patient's) room. The patient and his wife were very upset that we were not following the directions of one of his primary doctors [who does NOT work at our hospital, and thus does NOT have authority over us], repeatedly stating that it was just "common sense" to follow the orders of the doctor that is well trusted.
Sounds legit, right?
It's not.
Location, location, location. It's important in the medical field, too.
His favorite doctor, who I shall name Dr A for convenience of alphabet primacy, is an expert in a particular field. The point in question was about something else. Not in his field of expertise. So my co-worker had told the patient et al that he could take the medicines Dr A had prescribed (and which our corresponding doctors agreed with), but in the way that we recommended. Because based on our tests, if he didn't take the pills in the way sanctioned by our swallow pathologists [that's not a real department. I just called it that for explanation purposes.], the liquids would go in his lungs.
This is where the trust issue came in. The wife was more or less offended that we didn't trust the directions of Dr A. We were frustrated that she was trusting Dr A over experts in the field relevant to the problem. She was irritated that the nurse before me couldn't follow directions from said Dr. I was irritated that she thought all nurses did was follow directions.
Quick lesson here: NURSING JUDGMENT MATTERS. Did you know that if a lawsuit is brought up about a doctor's medical practice, a nurse will also be in the case and will be questioned for following a doctor's orders if that order goes against something the nurse "can be proven" to be obligated to know? I did not go to school, nor do I get paid, to follow orders. [if that's how nursing worked, man, am I in the wrong career. I hate being told what to do]. I get paid to THINK. And I went to school to know what to think about. The doctors call the shots, but nurses are supposed to stop the bullets that are going in the wrong direction. That is not to say I know more than the doctors, because I don't. I'm just supposed to be as smart as the doctors, to think as critically as the doctors. With less diagnostic and treatment knowledge, that usually means I'm just asking the doctor to explain the reasoning behind the order. Sometimes I learn something. Sometimes the doctor learns something. Because there is something nurses should know more than doctors: the day-by-day (more appropriately, hour-by-hour) state of the patient. How the patient is doing affects how the treatment will go down.
The object of our reluctance to follow Dr A's directions was not born from ornery insubordination, but from critical consideration. The object was to protect his lungs. First and foremost. Not to cover our butts, as was claimed (smart, but not true).
The result of the meeting was a stalemate, because we had lost a very important part of the patient-doctor relationship of trust, ironically because of an excess of trust for another.
I felt like they had cheated on me.
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