Facility Nurse Doesn't Get It...

[AtlantaRN, RN]

Lovely facility, and we are blessed to have 2 patients there...

New nurse consistently calls at the end of her shift to request "need a nurse to come and look at mrs. M," well by the time you call back, "she is gone for the day..." ask about the patient and the nightshift nurse says "oh, you know, regular stuff, she is just slowing down..." I go through this at least 3 times a week. Friday new nurse called to say "she has a thready pulse," but when you ask her what her heart rate is "80", so I go out there because they are a facility that we want more patients from because our census is so low....I go out there, 02 sat on room air is 98%, heart rate 84, peripheral pulses strong and PRESENT, blood pressure 114/56. It's a miracle!!! just my presence created peripheral pulses where there were none.:trout:

For the last 6 months we have been doing inservices bimonthly about "journeys end", and other topics, pretty much "what to expect when a person is dying," maybe i'm just overly tired because I do have a couple of patients who are actively dying.......It just seems like this new nurse wants me to "fix" the patients so they won't die, and it just isn't possible as I am not God...

Anywhoo, any ideas HOW to get through to this ONE nurse. It seems the other nurses "get it", but new nurse wants me to fix a thready pulse.....In hospice we don't do a fluid bolus...

Thank you for listening, rant mode off.

atlantarn

[llg, PhD, RN]

From a staff development perspective ... I would engage her in some problem-solving. In other words, find a nice way to ask " ... and what would you like me to do about that?" or "What are your expectations of me if I were to come out to assess the patient?"

She may just be calling you because she thinks she is supposed to be reporting these things to you. If she has no expectations for you to "fix it," but that she thinks she is supposed to tell you, you can use that as an opportunity to explain that she need not call with such reports. If she has an unrealistic expectation that you do something about the situation, you can use that as an opportunity to teach why such an expectation is unrealistic.

Engaging her in a conversation about her expectations and motivations for calling is the first step in finding out why she is calling. Before you do that, you won't be in a position to address it with her.

[Proud 2b Me]

There is a great little Hospice booklet called "gone from my sight" I was given this book to read one day when I was taking care of a Hospice patient in a Homecare setting . Your New Nurse may be uncomfortable working with dying patients, as Nurses we are taught to report changes in a patients condition but when caring for a dying patient changes happen quite often. Your nurse needs to see this as a natural process. I recall when the nurse on duty reported off to me that we would no longer be feeding the patient she stated "they are going to kill him" I had not had enough experience wtih hospice patients to know that this was infact not the case, the patient was no longer tolerating food and was going thru the dying process I too called the case manager often then one day she explained that I was there to help my patient thru this process of dying. I was there to keep him comfortable and to provide the care needed to maintain comfort not to help the patient recover "He was Dying" and after reading the booklet and excepting my role it this process I really began to see my patient differently I was there to provide end of life care not restorative care and truly understanding that made a world of difference for me.

[leslie :-D]

as a new nurse, she has much to learn.

introduce the dying process, it's probably very foreign to her since it gets little attn when in school.

it sounds like she needs further inservicing on working with the dying; what is 'normal' vs what necessitates further intervention(s).

i'm sure some friendly education would do wonders.

leslie

eta: sorry, didn't read the post thoroughly enough.

it sounds like this new nurse needs a more comprehensive 1:1 inservice, if she's the only one struggling with such ambivalence.

often i will get telephone reports of a pt and when i arrive at the facility, the nurse will say that she was merely just reporting; not asking for an intervention...usually from the newer nurses.