Monday, November 29, 2010

Attention Nurses-How To Be In The Top 50 Percent

My cell phone rang as I raced down the highway to the hospital.

"Hello Dr. G This is RN from the nursing home.....Mr. S is not looking good"

"What's wrong?"

"Heart rate is 250 and he is unresponsive"

"250? that doesn't sound right....how did you get that number?"

"That's what the pulse ox read!"

"Did you listen to his heart yourself to verify?"

"No"

"OK...whats the blood pressure, respiratory rate?"

"Hold on....let me ask the CNA"

"Never mind....I'm a minute away. check a stat cbc, cmp, get a set of vitals"

I walk in minutes later to find an alert, calm patient. Normal vitals signs and no distress. Apparently he was sleeping and the needle stick from the blood draw woke him up. An interrogation of his pacemaker/defibrillator would later show that he never had an elevated heart rate.

I get these calls all the time. Nurses calling with symptoms and vitals signs that make no sense. Riddled with incomplete information often on patients who they haven't laid eyes on. It drives me crazy.

The good news is that these scenarios do not occur with all nurses. In fact as far as the hospital and nursing homes go....about fifty percent of nurses are excellent. The other fifty percent...not so much.

In reality I don't know the trials and tribulations of being a nurse. It certainly is a complicated and difficult job. I don't want to pretend like I share their experiences. But I have been giving lectures on a weekly basis on nursing care. I believe there are just a few essentials skills that turn a mediocre nurse into a great nurse. Or at least the top fifty percent. Here's what I try to teach in my seminars:

Above all when calling a doctor to discuss a new clinical problem you must ...

Investigate

Please, please, please, please do not call me about a new problem without seeing the patient first. If there is a new rash...go look at it. A warm swollen leg...touch it. Don't take the CNA's word for it. If you call me I am going to ask you a lot of questions. You are going to be my eyes and ears. If you haven't investigated the problem yourself how can you see for me!

Anticipate

S0 the patient has a cough and crackles at the left base. What are the most recent vitals? When was the last chest xray? Is the patient on antibiotics already? Are there any drug allergies. If you call me and want a proper answer to your question come prepared. Have the chart, med list, and most recent labs in front of you. Because I will ask for this information anyway. You might as well have it ready.

Contemplate

Nurses are smart. I repeat most nurses are smart. They bring to the table clinical training, years of experience, common sense, and empathy. When you call me I want your opinion. Does the patient look sick? What do you think is going on?

I can't tell you how many times I have been stumped and turned to the nurse taking care of a patient and asked his/her opinion. Often that opinion helps me generate ideas or answers the question for me. I am secure enough in my abilities to ask for help. This is a team sport.

So that's it. Go from a mediocre nurse to at least the top 50 percent in three simple steps:

Investigate

Anticipate

Contemplate

And I will hold the greatest respect for you.

2 comments:

KimSetser said...

I feel your pain, and if I dare say so, I feel it worse because I was (am) a nurse. I worked first as a CNA, and then as ASN, BSN and finally a Nurse Practitioner and if I may so so myself, I was (am) a darn good nurse. I have worked in many areas throughout my career, and have left many of them due to what I perceive to be uncaring incompetent nurses. I could go on and on, so maybe I need to do my own blog about this (trouble is, a lot of those incompetent nurses are reading my blog)...maybe that's a good thing though. I'll leave you with one recent example: nurse says to me "patient in 401 says he's leaving AMA." I say, "is that the patient with new onset A-fib who just started coumadin last night?" and she says "yes, I think so, I'm pretty sure." I said "well, that's not a good idea, I need to go see him first." I go to room 401, the patient is gone, but was not the A-fib patient, he was the dialysis patient who is unable to mentally or physically care for himself and she allowed him to sign out AMA. that's another story for another day.
I enjoy your posts by the way.

Jordan Grumet said...

Kim....Thinks for stopping by

I enjoy your comments...by the way