Am I losing the ability to think like a normal person?

[JamiePedsRN, MSN, RN]

Hi PICU friends,

I should preface this question with some background, I've been in peds for three years and PICU since August. So, basically since August, I have been completely submerged in the delicate business of learning what is life-threatening and how to manage it.

I have found myself in the position(which I hate) of being asked to weigh in on peoples' sick infants and children. One was my niece, and the other was a close friend, so kinda hard to say no. When I look at these kiddos, I know that logically, they probably aren't all that sick, and they have excellent parents that are worried about them. But, I cannot stop my brain from thinking what if they've had an HSV exposure, or last night the kiddo has a high fever and warm, dry skin, I'm thinking "okay, what could be his source of infection that might lead to warm shock?" How do you remember how to think like a normal person and not come up with a life-threatening diagnosis??

On a side note, anyone found a tactful way to not give your nursing opinion to others?

[babyNP., APRN]

yeah, it's a hard line to walk. As a nurse you are trained to think of the worst possible thing to then go talk with the provider whereas the provider knows that most everything is horses, occasionally there are zebras, and rarely there is a unicorn.

A couple years back I had an uncle (who has been a nurse for 20+ years and very intelligent) call me because he was so worried about his daughter recently gone to college who was having some acute GI issues. He's asking me about an intestinal blockage, septic ileus, etc etc and I'm like "uncle! you're thinking crazy. If she doesn't feel better soon, have her go to urgent care and get it checked out. Shorter wait than the ED."

This is also why pediatrician offices generally have an on-call nurse to help triage whether something needs to go to urgent care/ED or whether it can wait to see the regular provider in the morning. Many insurance companies also provide this type of service. I would tell them that you're a nurse, not a doctor and you haven't done a physical exam on them and can't really give them medical advice. Direct them to the appropriate resources. If they're pushy, keep pushing back. I've had L&D nurses ask me on how they should manage a woman's labor (my license is only for those that are 0-2 years old) while working and I've told them, "no, that is out of my scope of practice plus it's not my patient." They didn't like that but I stuck to my guns. That is what the OB or midwife is there for- to take care of their patients. I only take care of the baby.

[NotReady4PrimeTime, RN]

It's tough being the person everybody turns to when there's a health concern. And it's scary to think we could give the wrong advice. So there's no reason why we can't just say, "You know, I'd love to be able to advise you on this, but it's really not anything I know that much about. Now... if you were asking me about _____________, I might be able to help. Have you talked to your doctor or NP about this?"

Side note: When did we start referring to physicians as "providers"? We are ALL health care providers!

[babyNP., APRN]

^^ it's how it was referred to me when I was in grad school a few years back. It's easier than saying, "The PA/NP/MD/DO." Might be a regional thing. The place in which I work now calls us "advanced practice provider" which is a mouthful still...

[llg, PhD, RN]

On a side note, anyone found a tactful way to not give your nursing opinion to others?

That is really not a side note -- it is the heart of the matter. If you are a PICU nurse, I assume you have a strong backbone and are not terribly thin-skinned. You have to call on those characteristics in such circumstances and tell friends/family to ask their health care provider -- not you. Simply say that you are not in a good position to judge "those things" because you are not the person's provider and that your expertise is on PICU matters -- not the common conditions they are more likely to have.

Good luck. I know it can be tough -- but trying to be everyone's substitute PCP will only get you in trouble in the long run.

[Caprica6]

It's tough being the person everybody turns to when there's a health concern. And it's scary to think we could give the wrong advice. So there's no reason why we can't just say, "You know, I'd love to be able to advise you on this, but it's really not anything I know that much about. Now... if you were asking me about _____________, I might be able to help. Have you talked to your doctor or NP about this?"

Side note: When did we start referring to physicians as "providers"? We are ALL health care providers!

I know that I when I say "provider", I mean it to include all types of healthcare professionals that have diagnostic, prognostic, and prescriptive authority.

[JadedCPN, BSN, RN]

In reality, you shouldn't be coming up with ANY diagnosis. Not only it is outside of your scope and a liability to your license, but think of the guilt you would have and potential resentment they would have towards you if you said the wrong thing/gave the wrong advice and it turned out fatal or even just with serious complications.

I've been a peds RN for 12 years so I know how it can be when everyone close to you comes for advice on their precious baby's snotty nose, but find a way to word it that you're comfortable with and learn to say no while advising them to talk to their PCP.

[JamiePedsRN, MSN, RN]

That is really good advice. Thank you!!