My Best Nursing Job Ever
I've stayed broadly in one branch of nursing - cardiac rehabilitation - for almost my whole career. But I've managed to find variety by taking on different roles during that time. I've worked inpatient and outpatient, I've managed the department for a while. Now I'm working per diem and am sort of the all around pinch hitter for the department and related areas.
But the very best period of my working life was when part of my job description was "cardiac liaison nurse". The bulk of my time in that job was spent in providing the pre- and post-op education for cardiac surgery patients. But the plum was that I would go into the OR a few times during each case and come out to give the family a quick update on how things were going.
Most of the time, it was just pure fun. At least 95% of cases went well. I just had to let the family know things were OK and how much longer to expect it to take. I do calm and reassuring pretty well, and had a good enough command of the technical side to answer almost any question that came up. Families were so grateful for the updates during the long and scary surgery that they thought I was wonderful just for being there.
But the memorable times, the times that stick with me many years later, are the few days that surgery did not go well. Those were the days I really earned my pay. They were the hardest days I've ever spent, but I was thankful for every one of them because they gave me a chance to touch families at such a deep level.
At that time, our surgeon, like most, was doing all his cases "on pump". During a normal case, I'd come out once early in the case to let the family know things were off to a good start. Then again about midway through and once more when we had come off pump - the re-starting of the heart. At that last one, I'd let the family know we had about an hour to go, to expect the doctor to come out at the end of the case, a little bit about ICU visiting and so on.
The most common scenario for a "not good" case was that everything would proceed pretty normally until we went to come off pump and found the heart unable to take the load. Usually, we'd go back on, let the heart rest a bit, give some inotropes and try again. Sometimes a balloon pump would be needed. But sometimes, nothing worked. We'd get a rhythm, but could not maintain a pressure with all the drugs and support devices at hand.
Once things started not being normal, my practice was always to let the family know they weren't going normally. I knew I owed them honesty. And that's when the tiniest detail would really start to matter. I wanted them to know things weren't right, that the situation was serious, but not make it sound worse than it was. Words, expression, body language, everything carefully calibrated to get the right degree of concern, but not destroy hope while any hope remained.
The longest case I dealt with had started at the usual early morning time. The first attempt to take the patient off pump was about 1130. The patient was finally pronounced dead at around 1800. For that last 6 hours plus, the surgical team was trying everything possible to get that patients heart to work. And I was back and forth every half hour or so to the waiting family with the latest news. With each of those families, I formed a special bond. Those were the families that would send the letters of gratitude.
I never was the one to tell the family that the patient had died - by ancient tradition that's the duty and prerogative of the surgeon. But I made sure it did not come as a surprise to them either. And walking down the hall with the surgeon to give that news, to be with him and them as he told them, I learned some lessons about accountability and what it was to be a "mensch" in the truest sense.
When all was done, I'd often cry with families and usually went to the funerals. But, as hard as those times were, I would not trade them for anything. I was grateful to be there to support those families, knowing that the most important thing I could share with them was not my knowledge or skill, but simply my humanity.Last edit by Joe V on Jul 7, '10 : Reason: formatting for easier reading
About Chico David RN
Joined: Oct '07; Posts: 650; Likes: 2,583
Cardiac Rehab Nurse; from USJun 30, '10My best was as a medical assistant and then an RN for the best doctor in the whole universe.Jul 1, '10Wow....what an article. I am a BRAND new nurse just waiting to transfer to Third Floor at our facility, which is Medical Oncology. I am hoping I LOVE LOVE LOVE my new job. I am well aware that there is LOTS of death on that floor, but am hoping I can help families in the same way you have. Thanks for being my inspiration. :redpinkheJul 1, '10Thanks so much for getting it and for your kind words. Back in the days when physicians almost never brought up "end of life" issues with patients, another very satisfying thing I often did was to sit down with a patient and family and explain the concept of "do not recussitate" and just let them know they had choices about their care. Another nursing role that can make such a difference.Jul 1, '10I have worked a variety of jobs in my 30 year career They one, well really 2, I enjoyed the most were both in corrections. One was a 600 bed max facility and the other a small county jail. I learned so much. You just see such a variety of stuff. Every day something new coming in the door. And I also had a lot of laughs. There is a big comradery between corrections staff and nursing. And I met some absolutely wonderful people who dedicated their lives helping to protect the rest of us.Jul 2, '10Wow, the liason job sounds great. When I first started in home health way back in the late 80's I was on the hospice team. I loved, loved, loved my job and my coworkers. I was well paid for those days, treated well by my hospital, and thrived on the freedom of independence that you get in home health. Unfortunately, home health has changed tremendously and the working environment is not like it used to be. A lot more stress now because so much pressure is put on the nurse to make money, not just care for patients. My agency went under.
The other job I had that was wonderful but did not last was a teaching job- I loved going to work every day and seeing new nurses grow and learn. Unfortunately there is little job security in teaching, and it is hard to get a secure position, so I moved on.
Nothing good lasts forever.Jul 2, '10Chico David..you and the manner in which you conduct yourself, in my opinion, exemplifies nursing excellence. Not everyone can do what you do. Nurses are so unique and authentic. It is not simply a career, nursing is a way of life, a lifestyle, really, and not everyone is suited for it.
I remember to this day when my mother had a CABG 20 years ago, and I will never forget and always be grateful to the nurse liaison for keeping myself and my family in the loop. I can tell you what she was wearing, what she looked like, her smile, her careful verbal and non-verbal communication...she is in our hearts forever. A family member would be so fortunate to have you as their guide, in a most scary time in a loved one's life. What a great article!!!!Jul 7, '10My favorite job was working on a mother/baby floor as the Discharge Nurse. I love teaching, so I loved being in this educator role. My main responsibility was to teach a morning discharge class to the moms going home, and I also was responsible for handling their discharge paperwork.Jul 7, '10BE CAREFUL, of how much you tell the family. The doctor in charge should be the one to tell the family!Jul 7, '10I assume you are referring specificly to the cases that don't go well. A couple of thoughts:
First, I had a real clear understanding with the doctors that they trusted my judgement on what to say and they wanted the families kept informed. Imagine letting a family think everything was alright and then having the doctor come out to tell them the patient died. If they were going to have to give that news, they wanted it not to come as a bolt out of the blue surprise.
Second, it would be immoral to let a family think things were going normally when that was not true, and once they know things aren't going normally, they deserve the information to understand the details to the best of their ability. I would never have accepted such work if I could not be honest with the families about what was happening.Jul 7, '10I have to agree with parrotlover... I never pictured myself working in corrections, but I love it. I am an ED, med/surg, outpatient, triage, and psych nurse all rolled into one! There is never a dull day, you always see something new! The best part is not having to deal with annoying families and call bells!!
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