Hustlin'

I had an interview today for a full-time staff nurse position. The floor is among my favorites at the hospital where I currently work as a PCA. I think it went well. I was told that "I articulated that very well" to many of the answers I gave.

Why Can't We All Just Get Along?

Why must there be this tension between doctors and nurses? It is this weird, pervasive feeling, the pink elephant in the room that no one openly acknowledges (except when in the break room of course), that manages to permeate every corner and orifice of the floor. Often the entire hospital. Any nurse who has stepped foot into the hospital cafeteria will tell you that the set-up is not so different than high school. There are cliques and evident segregation.

The nurse-doctor relationship has come a long way. However, it still has a way to go. Many doctors still do not understand exactly what nurses do. In the hospital hierarchy, nursing is considered the subordinate, not a separate professional field with it's own specialties and skills. Nurses may grow resentful of this perpetual lack of respect and understanding for what they spend 12 hours per shift doing and subsequently project this unhappiness onto anyone with an M.D. behind their name.

The other day, I had a patient who had been brought to the ICU after he had experienced some complications during surgery. By the time I had him, he was ready to be discharged to the surgery floor as he no longer required critical level care. While in the ICU, the patient was followed by the ICU team as well as the surgery team. Two teams following the progress of this patient, the ICU team more closely of course as they are a constant presence in the ICU setting, but surgery still checked in daily and added orders etc. But again, there is another another clash, the broadest of them all: medicine vs. surgery. Surgery would communicate with the ICU team if the spirit moved them. Miscommunication and subsequent bullshit issues will inevitably arise. As they did in this case.

Surgery came up in the morning. I was in another patients room doing my assessment and giving meds. The ICU intern came into the room and asked me why the NG tube on SK had been pulled. "I have no idea. The night nurse reported to me it had been pulled out and the patient had been allowed to take his PO meds with small sips of water." An experienced nurse knows not to pull a tube without asking the team first. I was confused as to why the intern didn't know the NG tube had been pulled out. It would have been her that authorized it. "Well," she replied, "Surgery is here and is angry that it was pulled. He wasn't supposed to have anything by mouth at all."

Well, the tube is out. "Well, the nurse wouldn't have just pulled it without any kind of authorization. Who gave the ok?" Silence from the intern.

So, long story short, surgery has their panties in a twist and says, "Well, we just want to EDUCATE who did this, find the breakdown in the communication. We won't call the nurse at home but we want to EDUCATE HER as to why this tube needed to remain in."

Apparently, surgery wanted the NG tube to remain for suction purposes as the patient had undergone some pretty extensive bowel surgery. This is understandable and a perfectly legitimate order. BUT IT WASN'T ORDERED ANYWHERE. Not in the patients chart, not on the computer ordering system. Therefore the reasonable conclusion in this whole ridiculous mess that the "breakdown in communication" occurred when surgery failed to document their desire for their patient's plan of care. The patient wanted the tube out, the typical protocol of a patient who is extubated is the NG tube gets pulled. Our team gave it the ok and the tube gets pulled.

But, nursing, of course, was the group to be "educated" by surgery.

During rounds, the issue was brought up.

"Yeah," said the intern, "it was probably our fault."

So why couldn't you have said that when surgery first asked about the tube?...