Friday, January 25, 2013

"A View from the Other Side of the Bedside"

I have been a Registered Nurse for just over 17 years now.  I have worked most of my Career in a Critical Care & Recovery Room environment. I have worked 11 of my 17 years at Kaiser Roseville.  

     I left Nursing School ready to fight for every patient, ready to advocate, stand in the gap, treat every patient as if they were my own family member.  I had this extreme sense of pride and felt as if I was fulfilling the “calling” or “mission” for my life. 

     Now, 17 years in, I still consider myself “above average” in most of those areas. However, there are areas in which I have grown complacent, grizzled, jaded and judgmental.  I rush.  I avoid eye contact.  I am annoyed by patients and their family members.  I am lazy, inflexible and if I am completely honest...I have lost sight of who I am and what I am called to be as a Registered Nurse.

     I believe in God. It says in the Bible that “in all things God works for the good of those who love him, who have been called according to his purpose.”  I believe that the experiences I have had over the last two weeks, although painful and difficult for my family and I, will be used to bring about “good” in my future as a nursing professional and in the lives of my future patients and their family members.

       On Saturday January 5th I received a call from my Mother-in-Law that my Father-in-Law had passed out and fallen in the garage.  I immediately encouraged her to call 911 and have my Father-in-Law taken to the hospital.  She did, and he was, and so began my metamorphosis as a nursing professional.  

     What’s interesting about this experience is that it is not necessarily new for me. I have had the roles reversed in the past. I have been a family member to a dying or ill loved one in a hospital setting.  I have also been a patient.  For some reason this time around has effected me on a much deeper level.  I can honestly say that my approach to my profession has been irrevocably changed.  

     My Father-in-Law was transferred priority one to another local hospital for severe Aortic Stenosis and underwent open heart surgery to replace an Aortic Valve.  After a fairly routine recovery it was decided that he was ready to be discharged.  I was unable to be with my family at the time he was being readied for discharge.  My family called with some concerns about the sounds of his breathing and his shortness of breath.  I encouraged them to bring this immediately to the nurses attention.  They did and were told that patients “can sound like this.”  After I got off of work I arrived to check on my Father-in-Law who was in extreme respiratory distress.  We called 911 and he was readmitted to Kaiser Roseville within 3 hours of discharge in respiratory failure and acute CHF.  

     I was now in that oddly uncomfortable place of knowing too much and not enough all at the same time.  That place that so many of us as health care professionals have been when we are thrust into standing with a family member through a trying medical experience.  You feel powerful and powerless.  You hold the credentials yet have no actual power to assert them.  You watch the others putting their stethoscopes on your family member, drawing labs, starting IV’s, giving meds.  It is a careful balancing act to maintain the perfect “poker face” while at times biting your tongue and holding your breath until you feel as if you may explode.  Then you finally decide to say something...You decide that it is time to drop that ever so subtle hint that you may know a little more than the “average bear”.  

   Admit it, as medical professionals we have all been there at one time or another. You are going about your business, caring for your patient.  Then you know “THAT FAMILY MEMBER” drops the hint.  Some of us choose to ignore it initially, all the while “uping our game” a bit in the off chance this person may actually know what they are talking about.  As the family members hints get more obvious, we at times grow more defensive.  That defensive dynamic that exists between the care giver and THAT FAMILY MEMBER”, is one that is difficult to explain but it is such a common reality.  A reality of which I have experienced first hand in a major way over the past two weeks.  The reality of this “dynamic” has contributed in a profound way to one of the areas of personal growth & transformation I feel that is happening in my career as a nursing professional.

     How does the saying go...”don’t judge a man until you have walked a mile in their shoes.”  Well I can say I have walked well over a mile in those shoes over the past two weeks.  Standing in the shoes of “THAT FAMILY MEMBER are the shoes of someone who is very afraid for the life of someone very dear to them.  They are the shoes of someone that knows and has seen the “worst of the worst”.  “THAT FAMILY MEMBER” has seen this situation their loved one is in and it hasn’t always turned out the way you are telling them it will.  They are most importantly the shoes of someone who is being looked at by other loved ones for answers and explanations and the pressure is great. 

      I have learned that rather than seeing this person wearing these shoes, as someone who is trying to outrun you.  More importantly see them as someone who is just there walking beside you through the process of seeking the best possible outcome for your patient and their loved one.  Welcome their questions.  Seek their input without being threatened.  Share information with them on a level they can understand and don’t condescend to them.  They are your team members in this race, NOT your opponent.  

     This “defensive dynamic” I speak of was much more “the exception” than it was “the rule” during my experience.  Especially at Kaiser Roseville.  However, it existed and it is because I experienced it that I learned so much about myself and the nurse I aspire to be.  

     You see I want to be a nurse and work with a team of nurses like the ones working the night shift in the ICU at Kaiser when my Father-in-Law was admitted.  We were so warmly greeted by everyone.  Anne his nurse gave us reassurance and helped encourage us to go home and get much needed rest.  I want to be the kind of nurse that leaves a lasting impression on you, like Hillary.  She had a kind, compassionate way about her that put all of us at ease.  I want to be a nurse like LaiLani.  She took the time to sit down in the midst of her very busy day and return my phone call to tell me how my Father-in Law was doing.  I want to always be a nurse with keen assessment skills like Monica & Becca.  They saw that my Father-in-Law was struggling, followed their instincts, made the right calls and made things happen.  They are incredible nurses and deserve to be acknowledged. I would like to have the same jovial bedside manner as Tony in the ICU. He kept my Father-in-Law in good spirits under a trying and difficult time.  I aspire to be a nurse like, Julie, who disarmed me with her peaceful spirit and warm reassurance when I felt out of answers.  I slept so well that night knowing he was in her care.    

     Finally I want to be a patient & family advocate like Joann in the ICU.  She stopped & listened to our concerns.  She then thoroughly assessed my Father-in-Law, passed the information on to Dr. Hajar.  He then took the time to meet with us, consider our requests and plan my Father-in-Laws care with them in mind.  We felt heard! 

     I have learned that we can NEVER underestimate the importance of those two letters next to our name.  We are Registered Nurses. With those two letters come extreme honor as well as incredible responsibility.  Regardless of how healthcare is changing there is one thing that will NEVER change.  We have the power to “make or break” a situation.  We have got to LISTEN to our patients and their families.  We have got to LISTEN to that inner voice inside that tells us something is not right!  We have got to be the eyes and ears for the Dr’s when they cannot or will not be at the bedside.  We have got to remind ourselves of who we are and why it is we do what we do!!!

     By no means am I saying I think I will now go out and be a perfect nurse.  In fact, I worked today and felt far from that most of the time.  What I can promise however is that I am going to be intentional with what I have learned through this.  I am going to take some time before I go into work each day and remember the lessons learned over the past couple weeks, both the good and the bad.  Finally, each day when I pin my badge on my uniform and put my stethoscope around my neck I am going to take a minute to recall my experiences from the other side of the bedside & thoughtfully consider my “calling”  as a Registered Nurse.