Grading Myself

In the grand scheme of things, I am a good nurse. 

I know this as surely as I know that the sun is shining and my balcony door is open.  I know this as much as I know that cardizem will lower heart rates but to watch the blood pressure… as surely as I know that I don't want to be the nurse giving ambien to anyone over 65 for the first time… as much as I know that regardless of what their oxygen saturation is putting a patient on oxygen will instantly make them feel better because it is something medical being done…

I had the same patients for 3 nights in a row.  I laughed with them, took them on walks in the hallway.  Called 2 doctors on 2 patients all 3 nights… blood sugar high. hemoglobin low.

Had a dude with a splenic infarct… think a heart attack in the spleen.  It is interesting having to worry about strokes and heart attacks and blood clots all at once… the doctor was convinced he was going to throw a clot from the dead spleen, we just didn't know where that clot would land.

I got floated on my last night.  Night 4, all of my patients were still here and they floated me to my least favorite place.  I think the time has come for me to stop being so nice and agreeing to do things I don’t want to do.  I need to talk to my boss about it…

I filled out the skills checklist for a couple of the traveling companies I am looking into working with, and then yesterday ended up talking to one of them… she said I didn’t do very good.  What?  Apparently I scored myself a 2.6/4.  She said you can usually tell the good nurses because they are honest… it is the people with a perfect 4 she worries about.  I think I took the test as a brutal self assessment of my skills, and now I need to take it again as  a selling myself to potential employers test.  I am a tad worried about the other skills list I filled out, though… haven’t talked to that recruiter yet.

I am a good nurse.  I know this as surely as I know that sometimes you don’t need haldol to calm down the slightly confused/agitated post stroke with expressive aphasia(aka can’t make sense with his words…), you just need to sit with him and hold his hand while he falls asleep.

As much as I know that sometimes a short walk in the hallway can make a patient totally depressed about his health smile again… look, I am getting better!

As truly as I know that sometimes (not always) giving 5 blood pressure medications at once is a stupid idea, as surely as i know that very few doctors care about anything not directly related to imminent death in the middle of the night, as much as I know that as a nurse it is my job to occasionally call doctors about things not related to imminent death because my number 1 job is to be an advocate for my patient.

I still fail fairly often at IVs.  I still ask questions. and more questions.  I still occasionally let my bags of Amiodarone run out, and avoid going into a patient’s room cause they give me the creeps. 

But still, I am a  good nurse.  I just don’t know how you put a grade on that…

 

The one in which I talk what little politics I know.

I get an e-mail every day from the ANA with the most important news articles regarding health care. I like it, because it keeps me updated on things going on without me having to search around for articles. I found an article that was very interesting to me, as it pretty much sums up the job I want to have some day. (not today, mind you. some day.)WSJ article
http://online.wsj.com/article/SB124873545269485081.html

I want to do long term outpatient care. Not in a nursing home setting, but it a HOME setting. I get so many repeat patients, frequent fliers as we call them. People with CHF, COPD, renal problems. I truly believe that if we could do more with them as outpatients we could prevent this. If I could call Mr. W once a weeks and talk to him about his meds and his weight and what his blood pressure was doing, if we could visit and I could check for swelling, if I could do this than he wouldn't know my name because I have taken care of him every couple of months for the last year.

And now I get political. IT ISN'T PAID FOR! Home health won't cover it, because most of our patients don't fall under the guidelines for qualifying. Apparently Medicare is now threatening to cut funding for repeat customers, and yet they aren't setting up programs to help pay to keep people out. The Massachusetts hospital that has a program like this had this to say:
"readmission rates for these patients (in the outpatient program) have fallen. But it isn't reimbursed for much of its efforts. "You do it because it's the right thing to do," says Diane Kelly, the hospital's chief operating officer. "But doing the right thing is getting expensive."
We could control this by helping with blood pressure, weight gain, swelling, etc. We can adjust outpatient meds to keep people OUTPATIENT.

"Attention to these issues can reduce readmission for heart failure by as much as 30% to 40%, according to pilot projects studied by Yale cardiologist Harlan Krumholz. But the services in such projects often don't qualify for reimbursement by private and public health plans. In a 2005 study, Dr. Krumholz and his colleagues reported that 13 of 15 successful projects to reduce readmissions were canceled after special funding for them ran out.
"These hospitals knew they had something that worked," Dr. Krumholz said. "But they couldn't come up with a business model that could afford it."

So here is what I am saying. If medicare and private insurance wants to keep people out of the hospital, they need to stop threatening us with taking away our funding, and instead start offering to fund some new programs. SERIOUSLY, HOW HARD IS THAT TO UNDERSTAND???

I really like this article. Things like this work. It is proven. There are stats. There just aren't enough programs like it. No offense, I understand that you think health care should be cheap, and that we add things just for the sake of it, but if hospitals are businesses and trying to make money we can't expect them to run programs for free. Here is something else. When I first got hired(or maybe when I was in school..) someone told me that patients will only remember like 10% of the education we do in hospitals. That is why we send so much printed paperwork home with people, so they can read it later. So don't get after us for not educating enough, not making sure people have enough and know enough to come back. WE EDUCATE LIKE CRAZY!!! Every time I give meds, talk about procedures, EVERYTHING i do with patients I am trying to educate, trying to do everything I could to keep them from coming back. Honestly, though, trying to teach while someone is sick isn't the most effective. Outpatient is.

Does any of this make sense? I am trying to put my thoughts into words... I might have to revise.


Winslow, Rob and Jacob Goldstein. Cutting repeat hospital trips--simple idea, hard to pull off. WSJ http://online.wsj.com/article/SB124873545269485081.html