Learning How to Not Be a Nurse
18Feb 25, '11 by NickiLaughs, BSNI have always been very analytical, very detailed, and have always been more than happy to acknowledge to others this, so they are aware that they do not have to talk to me in a more simplistic manner. However, that all changed on Monday, when my son became obviously ill, with chest retractions, and the beginnings of stridor. We took him to his primary location first, where I presented my obvious knowledge to the PA, who quickly began to berate me instead of focusing on my son. After I redirected the argument (all because she had misheard me say sore throat-thinking I had said strep throat), and got the focus on my son once again, she appeared to keep forgetting key assessment pieces on him and would return to the room momentarily with an "Assessment and Diagnosis for Dummies" book or something similar to use to diagnose MY son.
It became obvious we were getting nowhere, she stating he was fine, and us frustrated because we knew he wasn't. Off to the ER. This time, I stated no knowledge, just his symptoms, and we were whisked to triage and a room. The nurses were good, they explained things, I nodded blankly, and let them do their jobs. I put my trust in them and allowed them to focus on what they needed to do and I rocked my son. The PA came in, he was excellent, stating everything he was ordering, why, and what steps were next. I kept rocking and holding my son. They provided my son comfort, they gave him medications, I knew what the medications were, but I kept my mouth shut, and just observed. The head ER doctor came in, she made certain to tell me several times she was the head ER doctor, the additional tests she was ordering, and that the pediatrician would be in shortly. I nodded, kept my mouth shut and said thank you. I think at this point though they may have read our history and saw what my career was, because the information became shorter, but still compassionate. I however, still kept my mouth shut. They updated me regularly as my son was admitted, and I always was polite, and said thank you. It was hard for me to not involve myself in every little detail and analyze everything they were doing. I had become the scared parent, and simply focused on my son, because as I have realized, it is not always my job to be the best nurse I can be, sometimes it is just to be the best parent I can be.
2Feb 27, '11 by 2011NursingStudentDoctors should be capable of treating your son no matter how much you know, and being able to have an intelligent discussion shouldn't be a problem. I really don't understand...I think a parent should never have to sit and be quiet and feel they have to withhold questions or information, I think the first doctor you saw just wasn't very secure in what they knew and became flustered/defensive.
3Feb 28, '11 by SnowShoeRNI'm not a parent, but I don't think I would have been able to keep my cool in a situation like that. My sister gets the same way with her children (as I imagine I would) getting all fired up and assertive, but less nurturing/focusing on holding her child, etc.
I think doctors and PA's can sometimes be jerks because of our advance knowledge. Frankly, I think they can easily be intimidated by it. But I'm glad of my medical background and am firmly convinced that my knowledge of medicine has saved my life a couple of times. Case in point: firmly insisting that the resident in the ER get me a CT scan for my strange epigastric pain, nausea, and vomiting I had in November. They were ready to send me home after giving me a little morphine and zofran.
Turned out I had appendicitis. No RLQ pain, but appendicitis nonetheless. The resident was actually quite nice. The intern felt terrible. I ended up comforting him
But anyway... instinct is a beautiful thing and I think, when coupled with the extra-strong mom instinct AND nurse knowledge, it can definitely give us an added advantage when it comes to our own health.
I'm glad you got a better PA the 2nd time around and I hope your son is doing better.
1Mar 6, '11 by RetRN77As in many situations, it's not as much what we say, but how we say it. If we come across as aggressive as a patient or parent, we are often going to be behind the 8-ball. There are discussions elsewhere on this board about revealing or not, and they are very insightful.
I play it by ear these days, and one reason is that I'm retired and obviously although I try to keep up, current practice is not my forte. The other reason is that sometimes those who are insecure and those who are not may be put on the defensive. If I feel something is being missed, I'm not afraid to ask a question or make a mild suggestion. I still have to be advocate for my husband and adult son, but the first thing out of my mouth is not that I'm a retired nurse. The first thing out of my mouth is answering as thoroughly and accurately as possible the questions that are posed. Then we see what happens. I have to say I'm very impressed these days by most professionals I've encountered and can't think of many instances where I felt they've missed the mark.
0Mar 9, '11 by SusanRN82I had a recent experience with my 88 year old mother with advanced dementia, who had been placed in a nursing home because my dad could no longer care for her.
I was visiting her (I live out of state) and asked to see her MAR (I explained that I am a nurse). I noticed the usual medications and dosages for blood pressure and cholesterol, a multi vitamin, and 2 new drugs - an antianxiety medication ordered for HS and ...an antipsychotic (Haldol, of all things). When I asked the medication aide to describe the types of psychotic behavior my mom had been exhibiting and all she could say is that she paces around the facility and takes clothing out of her closet and drawers to fold and refold... typical dementia-like behavior, but certainly not psychotic.
So I called the prescribing physician and asked the receptionist to have him give me a call (this was on a Thursday). I called again, left another message the following day; the office nurse called to say that the doctor wanted to keep her on the Haldol. I then asked her to "help me understand" why my mom, who is exhibiting no signs of psychotic behavior, is being prescribed a medication with a black box warning about not administering this medication to the elderly who have dementia. She fired back at me and asked who I thought I was to be second-guessing the doctor. I immediately asked to speak to the doctor and was told he would call later - he did not.
Meanwhile, my mom was beginning to exhibit the classic side effects of Haldol - shuffling gait, dry mouth, etc. This time I asked my dad to call the doctor using these words: "help me to understand why an 88 year-old women with dementia, exhibiting no reported signs of psychoses, has a prescription for a medication with a black box warning." Long story short, the medication was discontinued within the hour.
My dad asked about what happens to people who don't have an advocate or someone to help with medical issues. My response - they're so screwed. I am first and foremost a loving and caring daughter, but I would be remiss if I didn't use my expertise to help advocate for a higher standard of care and to do what I can to ensure a better quality of life for my family.
0Mar 9, '11 by RetRN77I like your use of the words, "Help me understand." I'm going to have to remember that. I had a similar situation with my mom who's in assisted living in another state, regrettably. She has prednisone dependent aspergillosis. She had many changes of insurance plans and thus doctors before entering the facility, and had been in rehab for a broken hip. Things regarding her medications had been in disarray, and my brother nor my mother had a handle any more on her meds. She just kept deteriorating and was having a great deal of weakness and SOB, so finally I asked her if she was still on prednisone. She was so confused at this point that she had no idea. So I called the nurse's desk and asked them. They had no idea she'd ever been on it, nor about her diagnosis. I told them she couldn't be weaned off. She perked right up, but two weeks later, she was in the dumper again. I called again and found, yep, they'd tried to wean her off! This time, when I called, the nurse was somewhat snippy although I was patient with her, and I finally said to please have the doctor contact me. He did, he was very nice, capable, knowledgeable, did not get huffy and assured me they would not be attempting that again.
I was so glad I was able to intervene for her, as she would have died had I not. I was also grateful the doctor took my word for it, as the records regarding her aspergillosis and treatment had been lost. All I had to back me up was that someone found that she had been on prednisone while in rehab, but they didn't know why. The diagnosing physician had passed on himself, and no one knew who had been treating her more recently. Scary.
0Mar 9, '11 by floatnurse29I had the same experience but on the other side. My mother is a nurse as well and when I was in high school I had a major lower GI bleed. I was sent to the nearest children hospital and in turn The Doctor kept me NPO and done a EGD after I received 3 units of PRBCs. Yes a EGD!!! Keep in mind I was not vomiting had no c/o nausea. My mom kept her mouth shut and trusted the doctor to do what was right. Turned out the doctor gave me a regular diet again and told my parents he was going out of town and other doctors would cover. Mean while I was still having the horrible GI diarrhea. This pushed my mom over the top and jumped the doctor and he ended up quiting and sending me to another hospital where the doctor immediately done a colo and found colon polyps where one was "hot"! I found it amazing how just because my mom is a nurse and she didn't let them know they still didn't do their job and then when they did find out they couldn't handle the fact she called them on the mistakes they made. In a way its good to let them know and for us to not to be afraid to say that we do know wat is suppose to be done for our family.