I’ve been tagged by Shane over at nursingjobs.org. I am to tell you the the 4 things I can’t live without, followed by the thing that I covet. I immediately thought about material things (my scrubs? my stethescope? my clogs? The latest Prada bag?), followed by things of sustenance (Hazelnut latte? Donuts? Toasted Onion bagel? An icy cold Kettel one gimlet? well, not so much these days), and I realized that everything I need to do my job is either all in my head or out there in the ether. So here you go…
1. Good Assessment Skills
Good assessment skills are what makes a good nurse, in my opinion. This reminds me of something that happened to me when I was a nursing student on my unit. I was in my patient’s room doing all the normal things that I considered to be part of the assessment. My preceptor came up from behind and said, “Hey, do you notice anything strange here?” He then pointed out to me that my patient’s right breast was roughly three times the size of her left breast. She had a chest tube on her right side. It turns out that the breast had blown up like a balloon due to subcutaneous air.
In my defense I would say that the patient was placed on her left side, so that it was hard to see the asymmetry of her chest area, but still. Her breast was humongous! We confirmed that it was sub-q air because it had that crunchy rice krispy feel to it. I felt rather foolish that I had missed it but in the end I saw it for what it was: a valuable lesson. I was so busy looking at the monitor, testing her lines for blood return, checking placement of her NG tube, confirming vent settings, that I had failed to take a step back and really look at my patient and get the big picture.
2. The Internet
We come across so many different disease processes, infections, and medications. It is impossible to keep it all my head. With a computer terminal at every bedside, I can have answers within minutes. Not to mention access to every single protocol that I would ever have to use, which leads me to…
3. Protocols
Okay, I will admit it. I’m a protocol wonk. In the beginning we all use to joke about them, as in “Here at Ghoat we have a protocol to tell you how to blow your nose.” But I’ve come to love the protocols. One of my pet peeves at work is having to inform the resident about every little lab value that is out of wack, and then wait while they sit there, thinking out loud and trying to figure out exactly what to do. I’m not sure why they do this. I sometimes feel like saying, I don’t really need to be enlightened by your thought process. Just figure it out and get back to me with your course of action. Thankfully I have protocols that save me from making any breeches in professional courtesy. The protocol usually goes something like if the lab value equals “A” and criteria “B” and “C” have been met, then take course of action, “E”. This saves me so much time. We have protocols for electrolytes, insulin drips, heparin drips. We even have an ARDS protocol that tells respiratory therapists what vent changes to make according to the latest ABG.
4. Danskos
Okay, shoes are a material object. But I really can’t live without my danskos. For me there really is no other shoe (except for lately I’ve been wearing crocs because my feet are a little large). I can do 12 hour shifts for 3 days in a row wearing Danskos and not complain of foot pain. Now if only they would make an odor resistant model…
The One Thing That I Covet:
The chance to watch patients get better.
Especially the potential liver transplant patients. We take care of them when they are at their worst. They turn the color of mustard and you can hardly believe that they could have survived this far and then “poof” a liver appears and they get whisked off to the OR. And we never see them again.
I am so tired of seeing my patients die. It really wears on you after awhile.
And now, I officially tag May at about a nurse, and a fellow MICU RN at talkingRN.blogspot.com