Competent: Confidence: Caring

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I don’t have a lot of experiences with nurses — doctor’s offices, minor stays in hospitals, prostrate  treatment. The only nurse I really know personally is my sister, Marylee.  And we rarely talk nurse shop.  All that changed this past month.  I’ve met all types of nurses.  Some are nurse practitioners like Marylee.  Others Registered Nurses, just out of school or with years of training, then the Certified Nurses Aides.

September 17, Thursday, after 11 hours of surgery at Pennsylvania Hospital I woke up in a recovery room with an air tube in my throat.  Surprise.  The first nurse I remember seeing identified herself as Smiley.  An older African American women, she and I floated in and out of consciousness.  Soon a young Asian boy appeared  and said he was going to put a pump in my stomach.  He started with my nostril but had to go through my mouth due to the air tube I think.  Nasty.  Later I learned Peter wasn’t a high school student but a floor resident.  I kidded him about his youth; he dropped in to see me first thing almost every morning.   Thanks.

Still groggy, my next nurse identified herself as Angel.  Maybe I was in . . .  you know.  I think it was a new room.   Air tube and pump removed, I was feeling good Thursday afternoon.  It didn’t last.  Some liquids, upset stomach, vomit and I was back with a Nose Pump.

My nurse, maybe Friday,  was Maura.  She didn’t introduce herself but a white board in the room displayed names of on duty nurses and aides.  Maura seemed to be a young woman in trouble. She fumbled with my IV, was always fiddling with the Nose Pump, which would leak and generally not seem to be working.  She rarely spoke to me, explained nothing.  My confidence level in her was zero.  This was frightening.  I called in a resident physician’s assistant, Robert, who seemed to manage much of my day to day life.  I shared my anxiety with Maura and tried to rest.  That evening my Urology surgeon, Robert Kovell, stopped and we talked for a good 20 minutes or more.  When he left I felt relaxed and confident that all would work out.

Maura did get in thinking about the qualities of a good nurse — my three Cs.  Competent, Confident, Caring.

Competent are the skills learned through nursing school and with experience.  Diagnosis, dressing wounds, administering medications, IVs, blood pressure, assisting doctors and the list goes on and on.  I know very little of it.

Confident is the vibe a nurse gives to the patient.  You can tell by the touch of their hand, how they respond when something doesn’t work, the IV is constantly beeping, confidence tells the patient it’s not the nurse, it’s the machine.  Confidence is when it’s hard to draw blood but the patient senses the nurse is competent and confident and will eventually hit the right spot.  Frustrated nurse, anxious nurses, over wrought nurses, stressed nurses convey that to patients.  The result is that the patient is reluctant to push the call button, becomes anxious that things aren’t going well.  I suspect it’s not good for either the mental or physical health of the patient.

Caring is a bit of bedside manners.  The nurse treats the patient as an individual.  They know your name, ask about family, interests, fears and concerns.  The Caring nurse notices the picture the patient’s grandson drew “Get well Grandpop. When you are better, we can go fishing, Eli.”  Some nurses don’t seem to see individuals but a body in a wheelchair or bed.  They poke, probe,  wash, draw blood, administer meds to a body.  Assembly line nursing.

I had a bad experience the morning of my first doctor’s appointment in the city.  The nurse aide answered  a call, I wanted to get up before 7 to prepare for an 8 o clock pick up by Diane.  She refused (twice) telling me “they were coming.”  I pushed the call button  and waited until 7:35 when someone came  in with my breakfast.  I explain that I must get out of bed and due to the cathather bags cannot do it alone.  She said she was told I was self-sufficient.  She loosened the bags from bed and left.  I was fuming.  All my bags needed to be emptied; time to dress, no time to wash or eat; but rushed out into the hall where my nurse on duty is filling med prescriptions.  She knew I was headed for an appointment, in fact had papers and of meds for me to take. No concern I was left in bed.

I suspect these qualities of good nursing apply to aides, the guys who push gurneys around, and the many of other support workers that come in contact with patients.  I remember being pushed through the halls talking  and joking with the person behind the gurney or the person in a room when I waited for a test.  In other cases little if anything was said.  They had a job to do.  My advice find work in some other field.

In  the month I’ve been hospitalized, I have had contact with dozens of nurses.  A few named or names forgotten stand out.  Big John was a male nurse on my floor at Penn but not assigned to me.  At the same time he found time to get me up and walking at all hours  of the night.  Not sure why he had the time but I was so thankful.  There was Bill, the ileostomy nurse who patiently explained to Diane and me how to care for my new appliance.  An amazing guy.  One night an African American male nurse came in when I was screaming.  I explained the bladder spasm pain and I was scheduled to get meds.  He said he would take care of it.  And also promised to wash me up.  The evening passed.  Finally about 10, he came in, the meds for spasms was not available.  He left saying he woul take care of it. And 1/2 hour returned with the pill. I realized his shift ended, no wash up.  Then he returned again. “I said I would help” he said.  “But I’ve been so busy.”  I think he was overtime.

Christine and Erica my Occupational and Physical therapists at Manor were fantastic.  Christine and I wandered in the world of foodies while doing my exercise.  Ericka became my chief advocate and offered advice in dealing with the system.  Both will get some of my garden bounty before I leave.

My nurses have been male ( two Different Franks at Penn were very good) and female.  Chinese (Anna at Manor has been very gentle and friendly); threre have be quite a few Indian and African Americans.  Another Anna at Manor always seemed to answer my calls quickly with encouraging words.  Jackie at Manor has had been off, stressed moments, but also has been patient instructing us in appliance care and cleaning wounds.

Three of my favorite nurses were student nurses assigned to me personally at Penn. Two were from Villanova, the third from Jefferson. When they introduced themselves as student nurses, I immediately introduced myself as their teacher for the day. Fantastic conversations with all three.  Of of course I shared socratically my qualities of good nursing.

When I get home I want to read more about nursing.  A tremendously difficult job.  I am so thankful for those who treated me as an individual, listened to my complaints and brought their learning and experience to my care.  COMPENTENCE – CONFIDENCE – CARING    Thanks.

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