Sunday, May 17, 2015

Article Review: "Secrets" of Nurses

Someone asked me to comment on an article at Politico.com, "Nurse Confessions: Don't Get Sick in July."  So here it is.

The article is written by Alexandra Robbins, a journalist and novelist, to coincide with her newly released book, "The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital."

The article reiterates a theme that is still not widely accepted by the American public:  nurses, not doctors, do most of the work, including diagnosing and treating, and that nurses know more about what is going on with a patient than the doctor does.

Point 1:  Do not go to the hospital in July.
As disclaimed in the body of the text, this only applies to teaching hospitals in the United States because the new residents begin their training on July 1st.  I don't work at a teaching hospital, so I am not subjected to this.  Even if you end up hospitalized in July at a teaching hospital, you will have access to experienced doctors (and nurses).  This is not really an inside tip offered in secret by nurses; studies show that mortality increases in July.
I will add that staffing levels drop on major holidays, especially holidays attached to weekends, so if you can avoid having an accident or going into labor at these times, you will be better off.

Point 2:  Nurses are told to treat certain patients better.
This is absolutely true and it is laughable.  I have been told by administrators and other nurses to give more attention, or don't keep Ms So-and-So waiting because she is paying privately or has good insurance.  No.  My nursing time is given out based on medical needs, not bank accounts.  I prefer to not know how someone is paying for their stay, as it is an additional detail of no concern to me.  I don't get paid any extra when a patient has good insurance.

As for famous people getting private suites, well, money buys lots of things that the average person has no idea even exists.  A famous person attracts an entourage that would get in the way of delivering nursing care to any nearby patients.  Beyonce gave birth in a private wing of the hospital that cost her over a million dollars.  Nurses have told me about other famous people getting entire wings for themselves, complete with a full medical team and chef just for them.  And you can be fired for telling the press that the famous person is a patient at the hospital.  Most people are not at risk of strangers overrunning the hospital to snap pictures of them at delicate moments.  Famous people can buy privacy for these times.

Point 3:  Staff places bets on patient outcomes.
Yes, but not formally and not for money.  It's more like a human nature prediction, such as "I think he'll return from pass drunk like last time," while someone else says, "I think he's learned from last time and will be clean."  We don't hope for the worst.  It's hard to standby and watch someone self-destruct.

Point 4:  Codes and Slow Codes.
I have not seen this officially at any place as portrayed in the article.  Yes, the staff will work longer and harder to try to revive a younger person than they will an older person with terminal brain cancer.  The article hints at, but does not directly state, that this situation touches upon another misconception by the general public.  CPR (Cardiopulmonary resuscitation) is usually not successful.  It is brutal and causes physical damage to the deceased individual (that's right- CPR is performed on someone who is already dead!).  If the person comes back to life, the physical damage incurred during CPR may be too severe to overcome, and the person dies soon afterwards.  A younger person whose body is not already ravaged by disease has a better chance of being successfully resuscitated and recovering from the CPR than does an older person who succumbed to disease.

Point 5:  Nurses know secrets about the doctors.
Yes, by nature of our work.  This is true about any workplace, though.  This helps patients- nurses know which doctors overlook certain areas and which doctors know more about certain ailments or injuries.
Psychiatrists were specified in the article as avoiding patients.  Where I work, this is not true.  All of the doctors are very responsive and do not need to be told to do rounds.  They are receptive to questions and requests from the nurses and the patients.

Point 6:  People impersonate nurses.
Oh yes.  The people themselves who are mistaken for nurses rarely correct the assumption.  They even get upset when I speak up to correct the mistake.  Again, this traces back to the public's idea that men in healthcare are doctors and women are nurses.  Not only can women be doctors and men can be nurses, but most of the people who work in healthcare are neither doctors or nurses.  They are clerks, nursing assistants, patient care technicians, lab techs, housekeeping, dietary, recreation, security, and so on.  Some places color code the required scrubs so that nurses are readily distinguishable, but everywhere I have worked, there is no required difference in scrubs.
I visited a doctor's office where the medical assistant introduced herself as a nurse.  I happened to know her from a prior facility, where she was a recreation aid.  I asked her which school she attended.  She corrected herself, "Well, actually I'm a medical assistant, but it's the same thing as a nurse."  "No," I answered her, "It's not the same thing, hence the two different titles."
An instructor in nursing school warned us about this and told us to stand up for the value of the profession and always correct people who label non-nurses as nurses.

Point 7:  Use a larger needle than necessary.
I can envision this, but I have not personally done more harm on purpose.  A patient might hit you if he senses that you are inflicting more pain than necessary.  I've seen rough handling, but not consciously, but rather by caregivers not realizing how frustrated or angry they've become in the course of physically attending to an uncooperative patient.

Point 8:  Nurses lie.
More like not directly answering what was asked, because we have to for the sake of the patient and our job.
When a person asks, "What would you do if you were me?" my first thought is usually, "I would not have gotten myself into this situation."  But the patient's situation and life are not identical to mine, so what is good for me may not be good for the patient.  I respond more generally, without advocating immediate action, such as, "Let's gather all of the information and facts first.  Then we can discuss the situation with your support network and the doctors to see which course of treatment is most likely to deliver the results you hope to have."
We don't put down a doctor or a doctor's recommended treatment because that would subject us to dismissal.  Plus, we know that everyone is different and what didn't work for one person could be great for another.  We can discuss our concerns with the doctor and maybe change one of our minds.

Point 9:  DNR (Do Not Resuscitate) order may be ignored.
Yes.  DNR does not apply in some situations, such as during surgery or when dying from a sudden accident or trauma, such as choking.  Also, the medical personnel responding to your distress may not know that you are a DNR when they begin CPR.  They won't stop CPR simply because someone finds the DNR and waves it around.
Families can demand that CPR be performed regardless.  (See above for discussion of the fantasy revival.)  In the lawsuit-happy United States, the medical team may perform a light display of CPR, knowing that the person is not returning from the dead absent a miracle, hoping to make the family less inclined to stop at an attorney's office on their way to the funeral parlor.



1 comment:

  1. That is so interesting about treating patients differently - especially celebrities! It's not something you typically think about, but everyone does need medical care. Thanks for sharing this!

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