Tell me what you do!

[UM Review RN, ASN, RN]

It's generally agreed that the public does not know what nurses do. Never was this brought home to me so dramatically as when we nurses recently did some recruitment. It was set up as an "interview" scenario. My colleagues were, among others: an ICU nurse, an ER nurse, a Med-surg nurse, and myself.

We were asked what we do for patients. Silence. Then we stuttered. We stumbled. We mumbled. We ummm'd and ahhhhh'd.

Finally, one of us said, "We save their lives."

As the conversation developed, it did get better, but that initial question does afford us a good opportunity to educate the public about what we do. I was one of those whose voice was jammed in neutral, thereby shocking those who know and love me. But more than that, I came away believing that if we cannot answer that question quickly, firmly, and intelligently, we will by default, hinder the advancement of our profession.

Which translates into public apathy, which means that our working conditions don't improve.

So suppose the "general public" is asking you the same question: "What do you do in your day?" Convince me, John Q. Public, that nurses are worthy of respect, that nurses have a special body of knowledge, that nurses have to have education, experience, and expertise.

Please be specific, but please don't use too many medical terms.

[UM Review RN, ASN, RN]

I'm a telemetry nurse. In addition to college education for nursing as well as passing my state licensing exam, I have specialized training in Cardiology nursing. Cardiology nurses focus on heart and circulatory system problems. That means most of our patients are having problems with their heart and blood flow that can include hypertension, heart attack, stroke, or blood clots. We also have patients who are at high risk for heart problems, such as uncontrolled diabetics, people with chronic lung disease, or people with kidney disease.

When a patient comes to my unit, we place a monitor on his/her chest which transmits a signal to the monitor screen at the nurse's desk. We can see the rate the heart beats at as well as the heart's rhythm by looking at this monitor.

I have specialized training in how to read this heart rate and rhythm, and I have specialized training in how to treat any rate or rhythm that could cause the patient's heart to stop. Although we need to have a doctor's order for most of the things we do, we can do many things that don't require a doctor's order.

For instance, if a patient's heart stops (called a "Code" or "Code Blue"), I have ACLS certification--Advanced Cardiac Life Support--special certification that allows me to administer medications and procedures, such as CPR and defibrillation (which is an electrical shock that is applied to the chest) to get that patient's heart going before the doctor gets to the bedside.

Experience and expertise come into play in knowing what is happening and what types of treatment, if any, are needed. Nurses assess the patient's need to have treatment the entire time that the patient is on our unit, asleep or awake. Frequently, the nurse can do treatments without calling the doctor because of "standing orders"--a set of orders that anticipate typical problems encountered with that patient problem.

For instance, we have standing orders to give some patients a Nitroglycerin pill if they have chest pain. We will call the doctor to inform him/her, but we probably will not need further orders.

Probably one of the most important things we Cardiology nurses do is interpret lab results and other tests. Most of the time, a patient's lab results and other tests will be in normal range. Sometimes a lab test will prove that the patient has had a heart attack or a stroke. Sometimes a lab result means that the patient needs blood or treatment for too high or too low electrolytes (all of which can affect the heart's rhythm). We will report those results to the doctor, because in that case, we will almost always need new orders.

However, we cannot discuss those results with you, the patient. Only the doctor can. We also cannot tell you when your doctor has been called several times over a situation that the nurse has anticipated will need an order.

This is by no means a complete description of what I do as a nurse, but I hope it has shed some light on why nurses are well-educated professionals.

[NRSKarenRN, BSN, RN]

a must read to help improve communicating our nursing message:

from silence to voice:what nurses know and must communicate to the public

authors: bernice buresh and suzanne gordon

http://www.silencetovoice.com/

don't pass up an opportunity to hear them speak as you'll never be at a loss of words again.

[UM Review RN, ASN, RN]

Thanks for the reference, Karen!

So, having read that book, how would you answer the question?

[LPN1974, LPN]

I had the same question asked of me once, a long time ago on this same job I'm on now.

I hadn't been working there very long, but I gave about the same response that you did. I hmmm'd and ahh'ed , and this person said, "Well, I didn't mean to put you on the spot."

I thought other people KNEW what I did, esp. someone who worked in healthcare themselves.

Anyway, I wish I could go back and redo that little scenario but I can't.

And unfortunately, we might never get the opportunity again, but we do need to be prepared with an answer in case we are asked again.

I work in MR/DDS. My MAIN job function is passing out medications.

I have to know what these meds are that I'm passing out, why it is being given, the dosage range on it, and side effects.

I check blood sugars on several diabetics, by fingersticks, and give their routine insulin dosages and any on a sliding sclae that they need.

I also, give updraft treatments for respiratory illnesses and difficulties, and I give G-tube feedings to people who do not eat by mouth.

I take Dr's orders, that he has written, put it on the med sheet or any other appropriate place, make out the cards, and start the order if appropriate.

I work on the PM shift so I don't get the opportunity to work in the clinic therefore I don't know much that goes on in there, but we have several LPNs who do work in there. They assist with examinations of the people who come up to the clinic for complaints of illnesses or injuries. They also assist with yearly physicals with the MD.

I check vital signs on several people daily, some are scheduled weekly for B/P checks.

I give treatments: ointments for rashes, etc, routine eye gtts at bedtime, eye and ear gtts for infections as needed.

I change foley catheters monthly and PRN.

I followup on a variety of illnesses, seizure activity, skin conditions, broken bones, anything that our people may complain of or anything that the aides feel needs to be looked into, and document on a nurse's note re: these complaints and give the person an appointment to see the physician the next day, IF it can wait until then.

IF it cannot wait, I call the doctor and ask for permission to send this person to the emergency room for immediate evaluation of his/her problem.

I then prepare the chart with a complete nurse's note describing the problem,

a doctor's order for transfer, I call the RN on call and let her know what is going on, I call the family and report to them, answer any questions they may have, call the ER and give them a report of our patient in transfer.

I can take care of lacerations in some instances, if it isn't too deep or too long, I can elect to steri strip it or glue it myself, or I can have the person sent on to the ER for closure by a physician. I do close some myself if it isn't too deep, and if the person will let me.

I fill out incident reports on our people for anything that is UNEXPLAINED.....

any injury that no one knows what happened must be investigated.

Injuries to the face, esp around the eyes are incidents anyway and must be investigated thorughly.

I have to fill out the report, gather information from the people taking care of this person, find out who discovered the problem, and answer many other questions. These incident reports then go to the superintendant and then she examines it for completeness and accuracy and then the report goes to Central Office in our capital city.

Family has to be notified of any incidents on our people.

Nurses also have to followup on these incidents for 48 hours....we have to check on this person every shift for 48 hours. We assess the problem, do neuro checks, check their v/s, if it's a laceration we will change any dressings, and watch for infection, and keep a general watch on them, if the problem gets worse they will see the doctor.

We do alot of paperwork, we have to prepare the medication sheets monthly, make sure they are accurate for next month's work, make out treatment sheets for the aides in the homes.

We take monthly weights, heights yearly.

I will gather specimens, urine, or fecal for lab tests ordered by the MD.

I do not have to draw blood, and we don't have IV's where I work. If the person is ill enough that they need IVs they have to be admitted to the hospital.

We do breast exams on our females monthly, noting any changes and give the person an appointment with the doctor for anything we feel needs to be checked out further.

We reorder medications that need to be ordered in between the times that the pharmacist does refills.

Our people are on programs to help them learn to take their medications. They may be on something as small as just coming to the nurse or throwing away their cups, to opening a box and taking out the correct meds.

They do this every med round, and the nurse observes the person for their participation and documents. In some programs the person also does some documentation that he/she did his/her program.

We also give Hepatitis vaccines to the staff, when they are hired. They receive these injections during the first 6 months of their employement.

The nurses on the dayshift will give TB skin tests yearly to our people, then all nurses divide everyone up into assigments and we do the check on it 72 hours later, and document accordingly, for followup on anything positive.

We give flu injections annually to our people. Of course, consents have to be obtained, but that isn't in my job description, but alot of consents are required for things the people need, and for new psychotropic medications.

Those are my main job functions. There are many other small things we do, everyday, too numerous to mention.

Anything that comes up, if it needs attention or needs doing the nurses will do it. We do aLOT.

I really hope I'm not asked this question by anyone too soon, this is too much to remember and say. lol But I do have answer ready now, and I pity the person who should ask me....they better have plenty of time to listen, huh?

[menetopali]

i actually got that question in a tv interview last month (though that portion of the interview wasn't aired). my standard answer to that question is some variation on this: "i'm a college health nurse. i market good health to the college community, immunize students against tetorifice, diptheria, measles, mumps, rubella, and hepatitis b. i screen for tb. i provide instruction in safer sex, sexually transmitted diseases, abstinence, alcohol, illicit drug use, perscription drug abuse, sexual assault, nutrition, exercise, stress, and a myriad of other health related issues important to the college community. my function here is to educate our campus community and help them make positive health choices. in addition i provide nursing services to the campus community that includes refferals to physicians, over-the-counter medication administration, and first aid."