by NurseFirst

Hi,

On another thread here on allnurses, a student talked about how she advocated for her patient (titled "What would you have done?")

Since the more success stories we can provide people will help people see what a difference can be made, I propose this thread -- dedicated to encouraging nurses to advocate for their patients!!!

I'll start:

Last term (I'm still a student) I got two of my patients switched from MS (which wasn't touching their pain) to Dilaudid, with great success. (One pt actually could enjoy, in a coy sort of way, the bed bath his wife was giving him. A definite change from the 10/10 pain he'd been having ("It's so bad I could cry."--but maintained his stoic masculine self.)

Today, when the physicians were making their rounds I could not help myself to correct the teaching physician when he said the patient was getting tpn for nutrition. I said she only had 1 line, with 1 tubing going in, and the tubing going to the standard IV solution. They checked, and sure enough, the pt had stopped receiving tpn when they had to take the picc line out--2 days earlier--and she had been NPO since!!! (And no ng feeding.) Needless to say, the attending was in her room within 30 minutes (she is only 9 yo). She was extremely happy to get that ng tube out, too!

NurseFirst

Hi NurseFirst -

Have you noticed, since you started this 2 months ago, how many 100's have seen fit to add to, & contribute to your positive thread here. I do applaud you in your intention of making a positive difference.

Having worked as a devoted nurse for 32 yrs., I have lived multiple dozen contexts in which I realized the good fortune of guiding other people wanting their own happy
fulfilling successes.
The ones standing out above the rest are inevitably those situations, still
believed by the 'mainstream' as being "impossible to change". Well, evidently that wasn't the case. What helps you be successful in these, you may ask?
1. a genuine desire to bless others, which you seem to exhibit
2. un-common sense (not gotten from profs & texts)
3. insight, perceptive or intuitive in understanding inner nature
4. foresight, being able to see ahead
5. hindsight, yes understanding your own experiences
6. communication-flexible and adaptive
7. living faithful
and there are other skills, but this gives you a base to build on...

Personally, I have found it easier to 'stick my neck out' in making such positive differences, while working in the company of like-minded folk so inclined as well.
Tho, may be you enjoy laboring alone. Either way, it is a noble path to pursue, and one that will lead you to rich soulful *genuine fun* and countless other bounteous blessings

Since you used a Narcotic-analgesic example, here's 1 too:

This tiny, 61 yr. old, woman had deteriorated to the point that she was on MS around the clock, in high enough doses to slay a football team; plus she was taking it PRN. And yet,
her diabetic neuropathy agony was still thru the roof. Docs tried every Analgesic going, 'til all dosages were maxed out. Finally, all she could think, and talk, about was "suicide". This is how she, miserably, existed for over 10 yrs.

Asigned to my care, her children merely told me: "Good luck, you're gonna need lots".

Well, I won't bore you with too many more details. Suffice it to say,
one day a few months later, I got a call from her PCP wanting to know
"How come you haven't asked for more MS-refills, for her?". I said:
"How about you find out from your patient herself, ok?" as she told him:
"How about I come visit you, so you can see for yourself, ok?" and as she waltzed thru his Office door, he just couldn't get over the bouncy swing in her step, her cheerful Spring dress, her complementary new hairstyle, yadda yadda. The best part was, as she asked him "Dr. do you know of anybody who would like to be my travel-companion because I am soo ready to meet new people, make new friends and live the life of my dreams..." Her Doc was utterly speechless, for a long time after that.

And then, there was this 3 yr. old boy (whose PCP had already talked his parents
into planning his funeral arrangements) ...

oh, enough already, you're bright enough to figger out how this, and dozens of other, stories played out, so - Go forth, and help people plan their next :hatparty: fun party...

No matter how many people each of us may positively guide, and help, each of us will remain "human", making errors & mistakes. So, don't allow yourself to get trapped in "ego".

*just serve humbly grateful, joyfully happy, and have FUN !* :Melody:

Thank you both for posting!!! I'm not yet a nurse, but hearing your stories make me want to become a nurse even more.

I love the info on this board, and it's nice to focus on the positive differences nurses can make in patient care.

I'm looking forward to more posts!

Hugs!
MaryRose

Originally Posted by MryRose

Thank you both for posting!!! I'm not yet a nurse, but hearing your stories make me want to become a nurse even more.

I love the info on this board, and it's nice to focus on the positive differences nurses can make in patient care.

I'm looking forward to more posts! Hugs! MaryRose

Hi MaryRose,

Might your interest remain facilitating life's abundant goodness, meaning
healthy beliefs re yourself, sharing constructive fun, and empowering as many as you can into choosing likewise. in other words, 'making a positive difference' like you said.

Now, how might you translate these encouraging words into a proposed helpful, constructive Nursing-practice ... *fertility*: How can you help, women challenged in Conceiving.

YES you can positively help, for instance by -
1. choosing availing yourself of progressive books, tapes, videos, classes, and new friends rekindling your own awareness for helping people, currently stuck in a slew of chronic ills, expand into *positive generative beliefs* as well.
and
2. learning how to restore *Family-basic prolife* principles - feel free suggesting 'PRO-life' counseling for enabling a return to more balanced, healthful choices.
and
3. learning how to empower women into Allowing themselves enjoying the serenely blissful experiences of pregnating/birthing.

Attendant benefits for *both mom&bab* include Naturally-easier, faster, cost-effective birthing, recovery, nursing, etc.
and
4. learning how to empower Couples into allowing themselves *enjoying sharing children's wonderful fun discoveries...* - aka "successful Parenting skills".

And
beyond the satisfaction of your own internal peaceful assurance of "well done", will come many "Thank You's" for going the extra mile, in genuinely and successfully caring. Enjoy! :Melody:

I remember one situation when I was a brand new nurse, only a few weeks off of orientation. I had an elderly lady I was taking care of, she was a new admission that morning (I worked nights). She had CHF and was in renal failure. I should add here that I worked on a pedi med-surg floor and she was one of the rare adult med-surg overflow patients, so... not only did I not have a lot of nursing experience, but even less adult nursing experience. She had a room all the way at the end of the hall (never fails, eh?). So I did her assessment (pitting edema, no SOB at the time, pulse ox good, BP ok), administered meds, did her wound care (she had this weird skin condition that required dressings). All was fine.

An hour later I could hear her breathing from the nurses station. I am so not kidding. I ran down to see her with the pulse ox and she was in the 60s, obviously working very hard to breathe. I listened to her and she was very wet-sounding, a lot of fluid congestion.

Called doc from my mobile nursey phone. Doc told me he saw her earlier and looked at her chest film, her lungs are clear, our pulse ox is malfunctioning. He's sure that she is fine. I insist that she is not, he tells me I'm overreacting, he'll come see her first thing in the morning, and please don't call again and promptly hangs up in my ear.

So I called resp. I had this fantastic RT that came, agreed with my assessment, worked on bringing her sats up. Placed her on BiPAP. Drew ABGs. I don't remember her ABG values, but they weren't good. So I called the doctor back again, told him her ABG results, that she had been placed on BiPAP, her sats were up to the 80s, but she was still full of fluid. I told him that nothing was really going to help her until she got some fluid off her lungs so she could freaking breathe. He still didn't believe me.

In one of the snarkiest things I've ever done, I held the phone up to the patient so the doctor could hear her breathe. I then verified her code status and suggested the doctor take a vitamin in the morning so he could take over chest compressions when he came in. I got my order for Lasix, and her sats went up even higher. She remained on BiPAP and when the doc showed up (about 30 min after he talked to me the second time), she was transferred to tele.

I got a very nice write up from the RT about listening to my instincts and doing what was right for the patient when I had obstacles in my path. The doc never mentioned what I had done, but was super attentive whenever I called from then on and would often ask me what I thought would be helpful.

So, even as a new nurse one has instincts. Listen to them, not the doc who doesn't want to be yanked out of bed for a patient whose chest film was clear.

Originally Posted by CharmCityRN

I remember one situation when I was a brand new nurse, only a few weeks off of orientation. I had an elderly lady I was taking care of, she was a new admission that morning (I worked nights). She had CHF and was in renal failure. I should add here that I worked on a pedi med-surg floor and she was one of the rare adult med-surg overflow patients, so... not only did I not have a lot of nursing experience, but even less adult nursing experience. She had a room all the way at the end of the hall (never fails, eh?). So I did her assessment (pitting edema, no SOB at the time, pulse ox good, BP ok), administered meds, did her wound care (she had this weird skin condition that required dressings). All was fine.

An hour later I could hear her breathing from the nurses station. I am so not kidding. I ran down to see her with the pulse ox and she was in the 60s, obviously working very hard to breathe. I listened to her and she was very wet-sounding, a lot of fluid congestion.

Called doc from my mobile nursey phone. Doc told me he saw her earlier and looked at her chest film, her lungs are clear, our pulse ox is malfunctioning. He's sure that she is fine. I insist that she is not, he tells me I'm overreacting, he'll come see her first thing in the morning, and please don't call again and promptly hangs up in my ear.

So I called resp. I had this fantastic RT that came, agreed with my assessment, worked on bringing her sats up. Placed her on BiPAP. Drew ABGs. I don't remember her ABG values, but they weren't good. So I called the doctor back again, told him her ABG results, that she had been placed on BiPAP, her sats were up to the 80s, but she was still full of fluid. I told him that nothing was really going to help her until she got some fluid off her lungs so she could freaking breathe. He still didn't believe me.

In one of the snarkiest things I've ever done, I held the phone up to the patient so the doctor could hear her breathe. I then verified her code status and suggested the doctor take a vitamin in the morning so he could take over chest compressions when he came in. I got my order for Lasix, and her sats went up even higher. She remained on BiPAP and when the doc showed up (about 30 min after he talked to me the second time), she was transferred to tele.

I got a very nice write up from the RT about listening to my instincts and doing what was right for the patient when I had obstacles in my path. The doc never mentioned what I had done, but was super attentive whenever I called from then on and would often ask me what I thought would be helpful.

So, even as a new nurse one has instincts. Listen to them, not the doc who doesn't want to be yanked out of bed for a patient whose chest film was clear.

Good for you! Your advocacy most likely saved this patient's life. Thank so much for sharing this incredible account

Thanks, Vicky, but Wes (the RT) did most of the work. I felt so powerless. I told him I was giving the doc one more chance and then I was going to call the chief.

My first advocate experience was on my very first clinical day in nursing school. My patient had severe Pancreatitis and they were giving her Morphine Q3H prn. I learned while doing my prep that Pancreatitis and Morphine were contraindicated so I had to say something. It was really hard to do, I had never touched a patient in a hospital setting. I was intimidated and flustered, but I did it. I told the pts nurse that I found all these references about the contraindication and she told the doctor. That was so hard for me to do, because I have heard horror stories about nurses and students, and I was so afraid of coming off like a know it all. I apologized to the nurse before saying anything and I told her that I had to say something because we were taught to be the patients advocate and I had to do it. She sensed my trepidation and told me I did a great job and I would be a good nurse. Phew...disaster averted.

Originally Posted by CharmCityRN

I remember one situation when I was a brand new nurse, only a few weeks off of orientation. I had an elderly lady I was taking care of, she was a new admission that morning (I worked nights). She had CHF and was in renal failure. I should add here that I worked on a pedi med-surg floor and she was one of the rare adult med-surg overflow patients, so... not only did I not have a lot of nursing experience, but even less adult nursing experience. She had a room all the way at the end of the hall (never fails, eh?). So I did her assessment (pitting edema, no SOB at the time, pulse ox good, BP ok), administered meds, did her wound care (she had this weird skin condition that required dressings). All was fine.

An hour later I could hear her breathing from the nurses station. I am so not kidding. I ran down to see her with the pulse ox and she was in the 60s, obviously working very hard to breathe. I listened to her and she was very wet-sounding, a lot of fluid congestion.

Called doc from my mobile nursey phone. Doc told me he saw her earlier and looked at her chest film, her lungs are clear, our pulse ox is malfunctioning. He's sure that she is fine. I insist that she is not, he tells me I'm overreacting, he'll come see her first thing in the morning, and please don't call again and promptly hangs up in my ear.

So I called resp. I had this fantastic RT that came, agreed with my assessment, worked on bringing her sats up. Placed her on BiPAP. Drew ABGs. I don't remember her ABG values, but they weren't good. So I called the doctor back again, told him her ABG results, that she had been placed on BiPAP, her sats were up to the 80s, but she was still full of fluid. I told him that nothing was really going to help her until she got some fluid off her lungs so she could freaking breathe. He still didn't believe me.

In one of the snarkiest things I've ever done, I held the phone up to the patient so the doctor could hear her breathe. I then verified her code status and suggested the doctor take a vitamin in the morning so he could take over chest compressions when he came in. I got my order for Lasix, and her sats went up even higher. She remained on BiPAP and when the doc showed up (about 30 min after he talked to me the second time), she was transferred to tele.

I got a very nice write up from the RT about listening to my instincts and doing what was right for the patient when I had obstacles in my path. The doc never mentioned what I had done, but was super attentive whenever I called from then on and would often ask me what I thought would be helpful.

So, even as a new nurse one has instincts. Listen to them, not the doc who doesn't want to be yanked out of bed for a patient whose chest film was clear.

:hatparty: for being such an awesome advocate and especially as a new grad, speaking up

Originally Posted by CharmCityRN

I remember one situation when I was a brand new nurse, only a few weeks off of orientation. I had an elderly lady I was taking care of, she was a new admission that morning (I worked nights). She had CHF and was in renal failure. I should add here that I worked on a pedi med-surg floor and she was one of the rare adult med-surg overflow patients, so... not only did I not have a lot of nursing experience, but even less adult nursing experience. She had a room all the way at the end of the hall (never fails, eh?). So I did her assessment (pitting edema, no SOB at the time, pulse ox good, BP ok), administered meds, did her wound care (she had this weird skin condition that required dressings). All was fine.

An hour later I could hear her breathing from the nurses station. I am so not kidding. I ran down to see her with the pulse ox and she was in the 60s, obviously working very hard to breathe. I listened to her and she was very wet-sounding, a lot of fluid congestion.

Called doc from my mobile nursey phone. Doc told me he saw her earlier and looked at her chest film, her lungs are clear, our pulse ox is malfunctioning. He's sure that she is fine. I insist that she is not, he tells me I'm overreacting, he'll come see her first thing in the morning, and please don't call again and promptly hangs up in my ear.

So I called resp. I had this fantastic RT that came, agreed with my assessment, worked on bringing her sats up. Placed her on BiPAP. Drew ABGs. I don't remember her ABG values, but they weren't good. So I called the doctor back again, told him her ABG results, that she had been placed on BiPAP, her sats were up to the 80s, but she was still full of fluid. I told him that nothing was really going to help her until she got some fluid off her lungs so she could freaking breathe. He still didn't believe me.

In one of the snarkiest things I've ever done, I held the phone up to the patient so the doctor could hear her breathe. I then verified her code status and suggested the doctor take a vitamin in the morning so he could take over chest compressions when he came in. I got my order for Lasix, and her sats went up even higher. She remained on BiPAP and when the doc showed up (about 30 min after he talked to me the second time), she was transferred to tele.

I got a very nice write up from the RT about listening to my instincts and doing what was right for the patient when I had obstacles in my path. The doc never mentioned what I had done, but was super attentive whenever I called from then on and would often ask me what I thought would be helpful.

So, even as a new nurse one has instincts. Listen to them, not the doc who doesn't want to be yanked out of bed for a patient whose chest film was clear.

Great Job nursing is 60% instinct and 40% knowledge You can know everything they give ya in those textbooks and still have no idea what your doin! Go with your gut instinct, treat the patient and you can never go wrong