Hello, Nurse!

(mostly from a prior composition:)

I heard all throughout medical school (from multiple sources) to trust the nurses, utilize their input, keep them part of the team. I never thought I'd have a problem with that. And for the most part, they have been really good to work with. They really HAVE saved my ass - especially on my Cardiac Surgery rotation. As a bleary-eyed intern with no experience, it's nice to have ANYONE experienced who can remind you of what to look for and how to proceed when a patient is starting to look less than stable. There are really some great nurses at Rush University Medical Center.

And then ... there are some that make you cringe. I've been paged in the middle of the night for some of the most ridiculous questions and requests: "can you renew this medication that will expire in the AM?", "Do you know why this patient is a VIP?" I've been called to patients' rooms for "emergencies" like chest pain or shortness of breath - only to find it was a hiccup or mucus plug (ie, cough) or some other extremely transient state that any reasonable 2nd-year medical student would have not been alarmed at. Been called to put in orders on a patient that were already in, but the nurse didn't bother looking for them on the printer. Been informed by nursing that they were blatantly ignoring my order for giving a patient a fluid bolus because they were afraid the patient would become fluid overloaded - despite dropping urine output and raising heart rate (two cardinal signs of hypovolemia).

Needless to say, there is quite a range in the quality of the nurses we end up working with. And unfortunately there is almost no correlation with their personality or friendliness. I've been duped too many times already by confusing good people skills and sociability to quality nursing. And - surprisingly - there's not much of a correlation with how vocally the nurse advocates for the patient and the quality of care. "The squeaky wheel gets the grease," but sometimes pushing for action for patient A is distracting from the care needed for patient B.

I don't mean to rip on nurses - they are a more-than-critical component of patient care. They are actually the ones that perform the majority of day-to-day medical care for the patients, addressing fluid and medication administration, personal hygiene, wound care, monitoring vitals, as well as getting the patients up and about and prepared for procedures and tests. Not to mention addressing the social / spiritual needs of the patient, and advocating for anything left off in routine medical care. On rounds and during the day, I probably spend an average of 10 minutes TOTAL with any given patient - whereas the nurse is dividing his or her time among roughly 2-6 patients over an 8-12 hour shift. It is very fortunate indeed that nurses are available to advocate for the patients that they do get to know better than I. And sometimes there is surely cause for them to question doctors orders, especially given that interns have such limited patient care experience, whereas some nurses have been on the wards for decades.

And when I get to interact with a nurse that is working to collaborate on patient care, in a manner that is constructive and educational for all involved, it's a thing of beauty that I treasure. The system working, efficient, all the cogs in alignment. We're all the better for it, and it benefits the patient to the utmost.