A dream come true... graduation day, 1966
How proud I was... I could finally wear that white uniform and the cap of my school of nursing... Chestnut Hill Hospital, Philadelphia, Pa. The cap was the symbol of an eagle, and I was now ready to open my wings and fly free. Little did I know that this would only be the beginning of a long life of learning, and a life of caring. I had no idea how many people's lives I would touch and what a profound effect that these patients and their families would have on my own life.
I graduated with the award of excellence in bedside nursing. An ultimate reward for anyone wanting to spend a career at the bedside. But now I had an award that I would strive through the years to honor. I would come to understand that the most precious gift a nurse can give a patient is the gift of trust... the trust to care for your life and to be your advocate. Is there anything more daunting than to know you can make such a profound difference?
With this in mind... I share with you my experiences and look forward to your comments. There are millions of nurses in the world who on a daily basis give loving care to their patients, relieve pain, save lives, comfort the dying, provide support to families and do so with little public recognition. I celebrate each of these nurses and hope you will take the time to thank those nurses who may touch your life.
I have a job!
I was up early... my first day on the job.
I dressed in a starched white uniform, white stockings, white shoes, my hospital pin and carried my cap, prepared to begin my career.
I was nervous, excited and anxious to use my new skills in the workplace.
My first pay check... $150. The year was 1966.
My first job was in my community hospital... a hospital that was originally built in a cornfield. There was much talk at the time that we did not need a hospital in our town.
Some seemed to feel that it was OK to have our closest hospital 25 miles away but some forward looking citizens were responsible for the building and growth of this hospital and it's reputation.
My mother had major surgery in this hospital, my father died in this hospital and my children were born in this hospital.
It has grown by leaps and bounds and has become a well-respected teaching hospital.
I was part of the staff when we opened our first intensive care unit.
It was a transition period.
No longer would critically ill patients be cared for by private duty nurses but rather be placed in intensive care where monitoring was just becoming available.
I cannot tell you how exciting it was and I was sent to a program to learn the new technology and how to apply this new knowledge to the care of my patients.
It was the beginning of a life-long career.
How many times have you thought about a photo that you wish you had taken but did not?
I very much wish I had taken a photo of the cardiologist who guided us through the opening of our first intensive care unit. He was an exceptional teacher to the medical students, residents and also the nurses. He was well liked and a leader in the community.
It always made me smile to see him leave the hospital in his white coat and stethoscope around his neck. This is the picture I still hold in my mind... heading to his little bright orange VW "bug" with the vanity license plate: "LUB DUB" (the sounds of the heart!)
Working in my "home" hospital, I many times had to care for people I knew in the community. And this was the case when a man came into our ICU suffering a massive heart attack. He was in cardiogenic shock. His heart was so severely damaged that it could no longer pump effectively. I hung multiple intravenous drips and adjusted the medications as I repeatedly checked his blood pressure, pulse and monitor for response to the medications. These were the days before we had IV pumps and automatic blood pressure monitoring but we could continuously monitor his heart for changes. As I cared for him, I remembered how years before, his family was one of the few who built an underground bomb shelter. There was much fear at the time about the risk of a nuclear attack. Fortunately that bomb shelter was not needed; however, now, not even a bomb shelter could save his life. His heart was too badly damaged and in spite of drugs and monitoring he did not survive.
In caring for my patients, I understand the importance of family. Families are a major support system who will be there to help each other through the difficult times. It is so important as a nurse to not only gain my patient's trust but also that of the family. This is a great time of stress for everyone involved and if the family feels comfortable that their loved one is getting the proper care, at that point they can feel secure in leaving the hospital to get some rest knowing that if there should be a change in condition, that they would receive a call.
There is nothing nicer for a nurse to hear than the words "Oh, I'm so glad you are here!"
When times are tough, we all need someone to stay by our side.
I cared for an elderly gentleman who was admitted with a heart attack. He suddenly went into a lethal heart arrhythmia that we call ventricular fibrillation. He was unresponsive and his heart was no longer beating. I called a code and shocked his heart and was able to get him back to a normal heart rhythm. The remainder of his hospitalization was unremarkable and he was discharged with instructions to followup with his cardiologist. One year later this gentleman came back to the intensive care unit with a red rose in his hand. He said he had hoped I would be working because this was the one year anniversary of his second life. He thanked me for all of my care as well as that of the rest of the staff.
The same scenario happened for three years in a row... and then I did not see him any more and often wonder what happened to him.
As a nurse, you never know from day to day how you may be remembered.
Tuesday, February 17, 2009
The 1960's and 1970's greatly changed the direction of nursing. Nursing was thought of as a female profession... that only women could have the compassion and nurturing required to deliver nursing care. At the time there were only a small number of men who entered nursing. As women, we wanted equality in the workplace. No longer did we want to stand in respect to the doctors (who at the time were mostly men) and give them our chair when in fact it was the first we had sat down ALL day to do our charting. It was not that we didn't respect them but we wanted to work as a team. We did not want to be seen as hand maidens with no voice in the care of our patients. Feminism and women's lib was in the news and sparked a revolution. Gradually we took off our caps and changed our uniform to colors and then to scrubs as this was much more practical as we crawled on the floor to mark the drainage in chest tubes and it made the physical demands of our job easier.
Our skill levels were changing. We learned to do physical assessments that previously had been done by the physicians (hard to believe in today's world). We learned to insert IV's, insert nasogastric tubes, and became more assertive in voicing our concerns to the physicians. And our voices were being heard! We fought for a director of nurses who would indeed stand up for the nurses and support us as we sought more independence. I was fortunate enough to have a director who would not hesitate to speak loud and clear if a doctor spoke down to a nurse. She was pro-nurse and pro-patient and would listen to all sides before making a judgement. She stood for high standards and encouraged teamwork of all medical professionals.
Nurses today cannot believe how different it was back then. We live in a different world. Technology is rapidly changing and men are finding great satisfaction in entering the nursing profession and yes, they work in all specialties. There is greater comraderie between physicians and nurses. The doctors respect and rely on our assessments as their practices become busier. It is the nurse who spends time at the bedside and it is the nurse who carries out all the orders. We must work in tandem to deliver the care our patients so desperately deserve. No one can do it alone.
Nursing is best practiced as a team. It truly takes all hands working together to get the job done. I was fortunate enough to work with a great group of nurses. Years ago we were all about the same age. We were raising our families and became good friends. We shared the good and bad times together. Every few weeks we would meet at a restaurant called "Mother's" for breakfast. We ate peasant omelets, ordered a sinful dessert and ordered up more coffee. We talked about our children, our dreams, and our patients and work. I think these little get-togethers essentially worked like therapy. It helped us prevent burn-out in our profession and provided a support system we could depend on. I am pleased to say that these special gals are still friends today. Though we have all gone our separate ways, we keep in touch and share stories about our families and wonder if we will ever be able to retire.
Today, I work with a great group of nurses, and I have a supervisor who is very supportive of the staff and holds high ideals. But today, I am one of the older nurses. We hear of the nursing shortage and I am concerned that more students are not choosing nursing as a career.
Nursing is hard work, physically and emotionally, but it is one of the most rewarding and flexible jobs you can have. You can work full-time or part-time, days or nights, weekends or no weekends, hospitals or clinics, in the home or in industry, with an agency or as a travel nurse, or in the service to your country. You can choose your specialty, and you can go on to be a nurse practitioner. You can teach or you can work in research. You can fly medical transport such as Care Flite. You can be in administration or you can be a "worker bee".
As I age, I desperately want good nurses at the bedside because I know that someday I will depend on a nurse for my own care. It makes me proud to see my coworkers as they care for their patients.
There is an enthusiasm that I like and they have great technological skill as we rely more and more on computers and computerized technology. We share our skills and learn from one another.
I encourage anyone who might be interested in nursing... talk with a nurse. The field is wide open and there is great need.
It's a jungle out there...
Delivering nursing care is always based on priorities, and is a fine balancing act. Time management is essential and it must be accomplished as you tend to your patient's most basic needs. Let me tell you about my typical day...
My day begins at 05:45AM when I receive report from the night nurse on the patients assigned to my care. I will learn the diagnosis, history, allergies, and why they came into the hospital. We will review the doctors on the case as well as the physical assessment, vital signs, intake and output, lab results taking special note of abnormal labs and will review current treatments. We will also review all medications the patient is on as well as their response to the medications. Any tests or procedures to be done will be noted as well as preparation if needed for surgery. We review all the previous shift's orders and document that we have indeed reviewed and understand them. We visualize all special intravenous drips and calculations to confirm accuracy based on the specific orders, and check all ventilator settings for accuracy. We also discuss the patient's support system and possible need for social services or physical therapy to become involved. At this point I can make a plan for how best to care for these patients. It is now about 06:30 and I must do my physical assessments before the doctors make rounds.