Apparently a UK nurse was denied a Guinness World Record for running a marathon dressed as a nurse because she wore her work scrubs.
Although the category itself sounds kind of silly (are there marathons specifically for people dressed as nurses?) this line, courtesy of CNN, had my eyes rolling all the way out of my head and onto the floor.
Quote
Full-body scrubs are too close to the organization's definition of a doctor's costume, officials added.
Actual nurse, wearing her actual work scrubs: "Too doctor-y."
This guy, 'eligible participant' in the marathon: "Definitely a nurse."
I hate to pull the sexism card, but seriously???
Fortunately, BBC reports that rules are under revision, thanks in part to awareness by the runner herself, Jess Anderson. Hats off to Ms. Anderson for her big accomplishment!
Nurses in UK don't listen to heart, chest or bowel sounds. They may listen to apical heart if doing apex and radial (rare) but otherwise no. BP is done by machine - can still be done manually but would use ward/departmental stethoscope not their own. As an ENP I would treat chest wall trauma and then I would use the departmental stethoscope to listen for air entry but only the ENP's would do that, the other nurses in the Emergency Department would not use a stethoscope.
"What if the patient has cardiac, respiratory, renal, neurological, sepsis, G.I., or bleeding problems?" Simple answer is, they don't. This is a doctors problem not a nurses.
In 35 years in nursing I have only ever used a stethoscope for apex and radial testing (a very long time ago), BP's and as stated, on chest wall trauma that I was seeing as an ENP. In fact as I write this I can not remember the last time I took a BP using a stethoscope.
I have used a stethoscope during ALS, TNCC, ATLS courses but have never done it in real life on an actual patient.
ETA; doctors are going to listen to these things anyway so why should the nurses do work that is going to be done.
Should add that there may be areas like ICU where nurses use stethoscopes on their patients more but they would still use the department stethoscopes.
Thank you. This is very interesting. So the doctor would assess these systems using a stethoscope, and the nurse would carry out the treatment/s that the doctor orders, and then the doctor, not the nurse, would use a stethoscope to re-assess/monitor these bodily systems and assess/evaluate the effectiveness of the treatments. How often would the doctors do this monitoring/re-assessment? What types of patient assessment and monitoring do nurses in the UK do?
Thank you. This is very interesting. So the doctor would assess these systems using a stethoscope, and the nurse would carry out the treatment/s that the doctor orders, and then the doctor, not the nurse, would use a stethoscope to re-assess/monitor these bodily systems and assess/evaluate the effectiveness of the treatments. How often would the doctors do this monitoring/re-assessment? What types of patient assessment and monitoring do nurses in the UK do?
Not quite, yes doctors would do their assessment using stethoscopes but the nurse would have done their "nursing assessment." The doctor orders treatment but it is the nurses who evaluate effectiveness. In UK wards patients would see the consultant (senior doctor) at the ward round (probably every day depending on ward and condition of patient). Daily care is delegated to the junior doctor who tends to be based within the wards. The nurses then check patients as required and any problems noted are passed on to the junior doctor who deals with them or gets senior help. Part of the nurses job is to make sure that the junior doctors do not kill patients in their enthusiasm and that they contact the senior when required.
The actual assessments nurses do depends on the area they are working in and the illness of the patients. I was once asked by a (stupid) junior doctor to do neuro obs on a patient every 15 minutes overnight. He thought that was a good way to punish me for something he thought I had done. That soon stopped when I pointed out that a patient requiring that level of assessment belonged in a neurosurgery ward and that I would phone him every 15 minutes and tell him what the results were. He was also told that if he did not answer I would phone his boss and tell him the results. That was soon stopped.
Remember, in the UK ill patients should be transferred to the speciality area to deal with them, ICU, CCU, HDU. Mostly ill patients on a ward will be monitored, other patients will get 4 hourly obs or even daily obs.
ETA; for clarity, I have worked the last 25 years in ED so do not have up to date information on exactly what is happening in wards but the information I gave is true from what I saw going onto the wards and being a patient.
Do nurses do home care in the UK? There is no way I could assess my home care trach & vent patients without using a stethoscope.
Of course nurses do home care but what do you need to listen to? Is your patient saturating well? Are they undistressed? Are their obs within normal range? Then what are you worrying about?
This seems to be a fundamental difference between nursing in US and UK. You guys from my point of view go way overboard with testing and evaluating patients. If a patient is talking to you and undistressed then you can safely say that they are breathing properly - what their chest sounds are is totally unimportant to me as a nurse. Yes I know your ventilated patients won't talk.?
ETA; perhaps a UK nurse with more experience of home care of ventilated patients could add in their point of view as that is something I am not too familiar with.
I typically have home care clients who can easily get bronchitis or pneumonia. They quickly become very ill if we do not work to clear out the infection. And it is far easier to treat upper airway infections - including bronchitis - than it is to treat pneumonia.
If I listen to the lungs and note that the right lung is clear with good aeration, but the left lower lobe has popping rales with frequent squeaks (wheezes) and/or diminished aeration, then I will be aggressive in clearing out that left lung. I will monitor SpO2 (oxygen saturation), I will use the PRN bronchodilator, I will do percussion and postural drainage, I will encourage deep breaths & coughs.
If I know the problem is on the left side, then I will want to position to drain the left lung as much as possible. I'll put him on his left side sometimes, but he will spend most of his time (when in bed) on his right side, to drain the left lung.
I wouldn't have known which side to drain without using the stethoscope.
I will use a pulse oximeter, stethoscope, suction machine, nebulizer, jiggle vest, and cough assist, along with oxygen if needed. Usually, by getting the person up and/or doing the above, I can bring their SpO2 up without supplemental oxygen. Fix the problem, not the symptom.
Of course nurses do home care but what do you need to listen to? Is your patient saturating well? Are they undistressed? Are their obs within normal range? Then what are you worrying about?
This seems to be a fundamental difference between nursing in US and UK. You guys from my point of view go way overboard with testing and evaluating patients. If a patient is talking to you and undistressed then you can safely say that they are breathing properly - what their chest sounds are is totally unimportant to me as a nurse. Yes I know your ventilated patients won't talk.?
ETA; perhaps a UK nurse with more experience of home care of ventilated patients could add in their point of view as that is something I am not too familiar with.
Today in the US, patients who meet the criteria for hospitalization are usually very sick, often with many co-morbidities. As part of a nurse's scope of practice here we are expected to use our stethoscopes to assess the different bodily systems. The doctor may only see the patient once a day; acutely ill patients need close monitoring and careful assessment/timely intervention, and we are expected to do this and to inform the doctor of any deterioration in patient condition (sometimes subtle) so that the treatment can be amended (timely) as needed.
For example, many patients have heart and kidney problems; listening to their lungs with a stethoscope allows us to hear if there is a new change of fluid present (or if the current problem is worsening) and to inform the doctor, who may choose to order a chest x ray and/or a diuretic or another type of treatment. If we didn't listen to the patient's lungs the patient could continue to deteriorate, for example, with CHF/pulmonary edema, and when the doctor eventually listened to their lungs/heart the problem would likely be much worse and would require a greater degree of intervention. We try to recognize problems so that they can be treated at an early stage with better chances of recovery for the patient.
"One thing I've seen are orientations that are horribly lacking. There are either lackluster programs or no programs at all. New graduates are bounced between preceptors, preceptors lack training in preparing new employees, preceptors aren't interested in training, and understaffing make for bad training environments. "
I have found within my 6 years of being a nurse, one thing being consistent: preceptors aren't interested, because there is no incentive. I have been "chosen" by every employer I have worked for, without being asked, to be a preceptor for any new hire. I was never trained to be a preceptor. I have never been given any compensation for the extra time it takes to teach these new hires and take them under my wing. It got so frequent at my last job, that one of the new nurses jokingly asked management "why does she have to get stuck with all of us newbies". I went to management to ask for a raise or extra pay while precepting and they said no. It didn't use to be this way. I was a nurse's aid for 15 yrs before becoming an RN, and I remember being given an extra dollar per hour while training new hires. So it's no surprise at all that "preceptors aren't interested". I'd be more interested if it was worth the extra added stress in my day.
Susie2310
2,121 Posts
Thank you. This is very interesting. So the doctor would assess these systems using a stethoscope, and the nurse would carry out the treatment/s that the doctor orders, and then the doctor, not the nurse, would use a stethoscope to re-assess/monitor these bodily systems and assess/evaluate the effectiveness of the treatments. How often would the doctors do this monitoring/re-assessment? What types of patient assessment and monitoring do nurses in the UK do?