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Critical Thinking Healthcare Funny

This is what I mean when I say to get a second opinion

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"We're not going to tell you your doctor is incompetent, but if I say, 'You have the right to a second opinion,' that can be code for 'I don't like your doctor' or 'I don't trust your doctor.'"—Linda Bell, RN, clinical practice specialist at the American Association of Critical-Care Nurses in Aliso Viejo, California  Here's how to find a doctor you trust.

Before you gossip...

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“Feel free to tell us about your personal life, but know that we’re here for 12 hours with nothing to talk about. So the stuff you tell us will probably get repeated.” —A nurse in St. Petersburg, Florida

Sometimes we give more medication than we're ordered to

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"When a patient is terminally ill, sometimes the doctor won't order enough pain medication. If the patient is suffering, we'll sometimes give more than what the doctor said and ask him later to change the order. People will probably howl now that I've said it out loud, but you have to take care of your patient." —A longtime nurse in Texas  Here are some questions you should always ask before you take pain medication.

A lot of my patients are incontinent

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"I’m supposed to just use a wet washcloth to clean them. But if it's a patient who’s been really nice and appreciative, I’ll go all the way to intensive care to get some of the heated wet wipes, which are a lot more gentle. Somebody who's constantly yelling at me? I just use the washcloth." —A nurse in St. Petersburg, Florida

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I always remain calm

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"I've had people blow out arteries in front of me, where I know the patient could bleed to death within minutes. I've had people with brains literally coming out of their head. No matter how worried I am, I'll say calmly, 'Hmmm, let me give the doctor a call and have him come look at that.'" —A longtime nurse in Texas  These are the craziest things ER nurses have ever seen.

Yes, you were stupid not to come in earlier

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"I'd never tell a patient that he's a moron for waiting a week for his stroke symptoms to improve before coming to the hospital. Although I'd like to. Especially if his wife then complains that we’re not doing anything for the guy." —A longtime nurse who blogs at head-nurse.blogspot.com  These are the stroke symptoms you should never ignore.

Don't lie about your pain

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"If you're happily texting and laughing with your friends until the second you spot me walking into your room, I'm not going to believe that your pain is a ten out of ten." —A nurse in New York City   Here are some more things doctors and nurses wish patients wouldn't do.

Your life is in our hands—literally

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"We question physicians' orders more often than you might think. Some of the mistakes I've headed off: a physician who forgot to order a medication that the patient was taking at home, a doctor who ordered the incorrect diet for a diabetic, and one who tried to perform a treatment on the wrong patient." —A nurse from Pennsylvania

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People have no idea of the amount of red tape we have to deal with every day

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"We spend hours at the computer just clicking boxes. They tell us, 'If it wasn’t charted, it didn’t happen.' So I always chart with a jury in the back of my mind." —An intensive-care nurse in California

Hospitals are full of drug-resistant germs

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"Despite nurses' best efforts, hospitals are still filthy and full of drug-resistant germs. I don't even bring my shoes into the house when I get home." —Gina, a nurse who blogs at codeblog.com

These days, you can’t get admitted unless you’re really sick

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"And you'll probably get sent home before you're really ready. So we don't get any easy ones anymore." —Kathy Stephens Williams, RN, staff development educator for critical care at St. Anthony's Medical Center in St. Louis, Missouri   Here are some doctor-approved tips to shorten your hospital stay.

The No. 1 thing you should never say to me:

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"'You’re too smart to be a nurse.' I went to nursing school because I wanted to be a nurse, not because I wanted to be a doctor and didn’t make it." —A longtime nurse in Texas

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The sicker you are, the less you complain

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"I'll have a dying patient with horrible chest pain who says nothing, because he doesn't want to bother me. But the guy with the infected toe—he can't leave me alone." —An intensive-care nurse in California

I'll always come into your room with a smile

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"No matter how many times you use your call light, even if it's every ten minutes, I will come into your room with a smile. However, if you don't really need help, I will go back to the nurses' station and complain, and this may affect how the nurses on the next shift take care of you." —A cardiac nurse in San Jose, California  Check out these heartwarming stories about nurses who went above and beyond.

Over-the-counter drugs and herbals count as medications you take

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"When your provider asks for a list of the medications you're taking, make sure you include over-the-counter drugs and herbals. People think that if an herb is 'all natural' and 'organic,' it's not a medication. But that's not true. Herbals can interact with other medications and can cause serious complications." —Kristin Baird, RN, a health-care consultant in Fort Atkinson, Wisconsin

'Grey’s Anatomy'? We watch it and laugh

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"Ninety percent of the things doctors do on the show are things that nurses do in real life. Plus, there’s no time to sit in patients' rooms like that." —Kathy Stephens Williams, RN

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This is a hospital, not a hotel

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“I’m sorry the food isn't the best, and no, your boyfriend can't sleep in the bed with you." —A nurse in New York City  Learn the secrets hospitals won't tell you.

I'll wait for the doctor to tell you about test results

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"If you ask me if your biopsy results have come back yet, I may say no even if they have, because the doctor is really the best person to tell you. He can answer all your questions."—Gina, a nurse who blogs at codeblog.com

Nurses can be mean to each other

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"In my first nursing job, some of the more senior nurses on the floor refused to help me when I really needed it, and they corrected my inevitable mistakes loudly and in public. It's a very stressful job, so we take it out on each other." —Theresa Brown, RN, an oncology nurse and the author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between

It's stressful when a physician makes a mistake

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"It can be intimidating when you see a physician who is known for being a real ogre make a mistake. Yes, you want to protect your patient, but there's always a worry: Am I asking for a verbal slap in the face?" —Linda Bell, RN   Learn what happens when doctors make life-threatening mistakes.

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I hate being blamed for things that aren't my fault

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"Every nurse has had a doctor blame her in front of a patient for something that is not her fault. They're basically telling the patient, 'You can't trust your nurse.'" —Theresa Brown, RN

A positive note from you can go a long way

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"If you have a really great nurse, a note to her nurse manager that says 'So-and-so was exceptional for this reason' will go a long way. Those things come out in her evaluation—it's huge.” —Linda Bell, RN

I love when you come back and visit

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"If you've been a patient in a unit for a long time, come back and visit. We'll remember you, and we'd love to see you healthy." —An intensive-care nurse in California

We still believe in miracles

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"I once took care of a child who had been in a coma for more than a week. The odds that he would wake up were declining, but I had read that the sense of smell was the last thing to go. So I told his mom, 'Put your perfume on a diaper and hold it up by his nose to see if it will trigger something.' The child woke up three hours later. It was probably a coincidence, but it was one of my best moments as a nurse." —Barbara Dehn, RN, a nurse-practitioner in Silicon Valley who blogs at nursebarb.com   Read more stories of miraculous recoveries from nurses and doctors.

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Nursing is incredibly demanding

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"Some jobs are physically demanding. Some are mentally demanding. Some are emotionally demanding. Nursing is all three. If you have a problem with a nurse or with your care, ask to speak to the charge nurse [the one who oversees the shift]. If it isn't resolved at that level, ask for the hospital supervisor." —Nancy Brown, RN, a longtime nurse in Seattle

Demand their attention

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“Now that medical records are computerized, a lot of nurses or doctors read the screen while you’re trying to talk to them. If you feel like you’re not being heard, say, ‘I need your undivided attention for a moment.’” —Kristin Baird, RN

Never talk to a nurse while she’s getting your medications ready

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"The more conversation there is, the more potential [there is] for error." —Linda Bell, RN

Nurses shouldn't miss your vein

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"If the person drawing your blood misses your vein the first time, ask for someone else. I've seen one person stick someone three times. They need to practice, but it shouldn't be on you!" —Karon White Gibson, RN, producer-host of Outspoken with Karon, a Chicago cable TV show

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Never let your pain get out of control

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"Using a scale of zero to ten, with ten being the worst pain you can imagine, start asking for medication when your pain gets to a four. If you let it get really bad, it’s more difficult to get it under control." —Nancy Beck, RN, a nurse at a Missouri hospital  These are the secrets pain doctors won't tell you.

Drink lots of water before having your blood drawn

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"If you're going to get blood drawn, drink two or three glasses of water beforehand. If you're dehydrated, it’s a lot harder for us to find a vein, which means more poking with the needle." —Mary Pat Aust, RN, clinical practice specialist at American Association of Critical-Care Nurses in Aliso Viejo, California

Don't hold your breath before a painful procedure

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"Don't hold your breath when you know we're about to do something painful, like remove a tube or take the staples out of an incision. Doing that will just make it worse. Take a few deep breaths instead." —Mary Pat Aust, RN

Try to avoid hospitals in July

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"If you have a choice, don't go into the hospital in July. That's when the new crop of residents starts, and they're pretty clueless." —A nurse supervisor at a New Jersey hospital

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Doctors don’t always tell you everything

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"They’ll be in the hallway saying, 'She has a very poor prognosis. There's nothing we can do.' Then they don't say that in the room. Sometimes I try to persuade them to be more up-front, but I don't always succeed." —Theresa Brown, RN    Learn what doctors are thinking (but won't say to your face).

Many doctors seem to have a lack of concern about pain

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"I've seen physicians perform very painful treatments without giving sedatives or pain medicine in advance, so the patient wakes up in agony. When they do order pain medicine, they're so concerned about overdosing, they often end up underdosing." —A nurse supervisor at a New Jersey hospital

Always ask anyone who comes into your room if they've washed their hands

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"There are a few doctors at every hospital who just don't think that they need to wash their hands between seeing patients. Others get distracted and forget. So always ask anyone who comes into your room, 'Have you washed your hands?'" —Kathy Stephens Williams, RN   And make sure you don't make these hand-washing mistakes yourself, either.

Please give physical affection to dying loved ones

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"When you're with someone who is dying, try to get in bed and snuggle with them. Often they feel very alone and just want to be touched. Many times my patients will tell me, 'I'm living with cancer but dying from lack of affection.'" —Barbara Dehn, RN, NP   Here are some other things you should never do while visiting someone in the hospital.

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It’s the little things that make a difference for people who are sick

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"One of the best things you can do is wrap them in a warm blanket or towel. Throw the towel in the dryer before they are bathed. If they're in a hospital, find out where the blanket warmer is." —Barbara Dehn, RN, NP

I may talk to family members to clarify their goals for the patient’s care

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"I'll never tell you to change your code status to Do Not Resuscitate, even though I might cringe at the thought of having to break your ribs during CPR. With certain patients, however, I may talk to family members to clarify their goals for the patient's care. This sometimes leads to an elderly person being placed on comfort care rather than being continually tortured by us with procedures that aren't going to help." —A cardiac nurse in San Jose, California

The doctors don't save you; we do

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"We're the ones keeping an eye on your electrolytes, your fluids, whether you're running a fever. We're often the ones who decide whether you need a feeding tube or a central line for your IV. And we're the ones who yell and screech when something goes wrong." —A longtime nurse in Texas

Husbands, listen to your wives if they tell you to go to the hospital

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"Today a man kept fainting but wouldn't go to the hospital until his wife forced him. He needed not one, not two, but three units of blood—he was bleeding internally. He could have had a cardiac arrest. Another man complained to his wife that he didn’t feel 'right.' His wife finally called me to come over to their house. His pulse was 40. He got a pacemaker that evening." —Barbara Dehn, RN, NP   Here are some more mistakes you make that can lead to a misdiagnosis.

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If you do not understand what the doctor is telling you, say so!

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"I once heard a doctor telling his patient that the tumor was benign, and the patient thought that benign meant that he had cancer. That patient was my dad. It was one of the things that inspired me to become a nurse." —Theresa Tomeo, RN, a nurse at the Beth Abraham Center for Nursing and Rehabilitation in Queens, New York  These are the medical facts that doctors and nurses want everyone to know.

At the end of an appointment, ask yourself: Do I know what’s happening next?

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"If you had blood drawn, find out who's calling who with the results, and when. People assume that if they haven't heard from anyone, nothing is wrong. But I've heard horror stories. One positive biopsy sat under a pile of papers for three weeks." —Kristin Baird, RN

Sometimes you do nothing but run numbers and replenish fluids

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"Sometimes you're also the person who reassures the teenager that 'everybody' gets her period on the day of admission, the person who, though 30 years younger than the patient, tells that patient without blushing or stammering that yes, sex is possible even after neck surgery. You're the person who knows not only the various ways to save somebody else's life but also how to comfort those left behind." —A longtime nurse who blogs at head-nurse.blogspot.com

Know when to draw the line

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"I had one patient show up repeatedly to see me after he was discharged. Another little old man tried to pull me into bed with him. (He was stronger than he looked.) The general rule is don't ask us on a date. We're busy. It's unethical. And, really, I already know you better than I want to." —A longtime nurse in Texas

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Say thank you

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"A simple 'Thank you' can really make my day." —A nurse in New York City

I don't have time to wait on you

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"I know you asked for mashed potatoes, but that sound you hear is my other patient's ventilator going off." —A nurse in New York City

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Sometimes I have to lie

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"When you ask me, 'Have you ever done this before?' I'll always say yes. Even if I haven't." —A nurse in New York City

More: Conditions, Everyday Wellness, Health Care

I am a proud, critical care nurse, and I have been in that specialty for the majority of my nursing career. Over the years I tried different areas to give them the benefit of the doubt, and I've worked anywhere from a rehabilitation center to hospice. But I've always gravitated back towards intensive care. I suppose it just suits me.

Over the years I have been approached by more than a handful of nurses who ask about critical care, and they'll bounce the idea of them trying it out with me. It typically goes something like this:

"I've been thinking of becoming a critical care nurse. I'd love to just have two patients. I'm just so tired of the hectic pace of ________ (insert specific field)."

Honestly, I'm always happy when a nurse shows interest in my favored area. We are always on the lookout for a fresh new recruit after all, but there is that part of me that raises a brow. I am reminded of the Spaniard from Princess Bride, and I want to reply, "I do not thinka it means what you thinka it means."

While dropping from a patient assignment number of six to an assignment of two sounds fabulous, there's a bit more to consider. Sometimes you even get to have just one patient, and that's where the fun really begins.

In critical care you might enjoy being in the room with your single patient, but I would suggest taking it easy on the water since you will be unable to leave that patient's side. The machine inserted in their body to help their heart pump blood requires your constant observation. But you won't even notice not getting a potty break or lunch break. You'll be far too busy recording hourly vital signs, hourly abdominal pressure, hourly central venous pressure, cardiac output, and such.

In between that you'll stay occupied obtaining hourly blood sugars, hanging six different antibiotics, and constantly titrating dangerous cardiac medications to sustain blood pressure and heart rate within parameters that are compatible to life.

All the while don't forget simple tasks like controlling pain, sedation level, suctioning of endotracheal secretions, and assisting with bodily eliminations and bathing. No, there's no nursing assistant to help with this.

You'll be kinda busy so hopefully they won't try to die on you.

If you don't have this one patient, you'll be gifted with two. Other than a balloon in their aorta your two patients may likely require all above interventions plus a trip down to CT. They're all full codes, by the way.

Okay, so I'll admit it's not always crazy. Sometimes you get a pretty good patient, and you find yourself retrieving water or walking someone down the hall. That's pretty awesome, right?

But I ask this. Have you ever seen a duck gliding across a pond? They seem so motionless as they maneuver through the water, and only small ripples are even glimpsed to let you know they're moving. What you cannot see are the frantic kicks below the surface. Critical care is kind of like that.

Critical care patients are like a smoking volcano, and there's no way to know when or if it might erupt. Sometimes you see the build-up before it explodes, but sometimes you don't. Sometimes you don't see the frantic kicks trying to keep your patient above water, but you know they're there.

This is why a patient is in critical care, and if you're a critical care nurse you understand that at any moment, often without warning, your patient may crash. Their vitals will plummet, their breathing will become distressed, and they will code.

Every moment spent in critical care is spent in a mindset of watchful anticipation, until it is not. Then it becomes action. Life-saving, fluid action.

So even if you have had a good day thus far you are always prepared for it to decline quickly. Sometimes it doesn't. But often times it does.

Critical thinking is a requirement, and critical thinking requires being able to see the forest despite the trees. Patients surrounded by a dozen monitors and alarms sounding still need to be treated for pain. A smiling, talking patient can still be circling the drain. Even with everything going on with an intensive care patient, low blood sugar is still a frequent cause of problems. And you always still revert back to your ABCs.

I'm grateful for all my MedSurg and floor nurse co-workers. They do the job I cannot do! I've worked MedSurg before, and I can tell you that having six or seven patients is crazy, busy. It's hectic. But having two is no less hectic. It's just a different kind of busy.

Often times it seems like the grass may be greener on the other side, but if my time in nursing has taught me anything it is this; nursing is hard no matter where you work. No matter what specialty area you are in you will be required to intervene for the life of your patient. No matter where you work you will be expected to do more than you feel like you are physically, mentally, and/or emotionally capable of achieving. This is the life of a nurse.

I know on my end that being a critical care nurse is like Forrest Gump's box of chocolates. You never know what you're going to get. But if the above doesn't scare you, and you can focus on multiple issues in a high stress environment, then we'd love to have you. If you're interested in joining my crew come on down. We'll find something for you to do for sure.

Originally posted at: http://briegowen.com/2015/01/26/become-a-critical-care-nurse-they-said-it-will-be-fun-they-said/

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