When the Nurse is the Patient…..

I literally hate writing in first person, so for this article I will become “Pam,” the seasoned nurse who has been a nurse for a very long time but NOT a patient. Pam is going to share a few key points for new and seasoned nurses to be aware of when giving care. Pam had part of her colon removed some time back, and eight years later she was diagnosed with a small bowel blockage that turned into a month long stay in the hospital. No one should have to endure a month in the hospital, but for a nurse it was certainly a HUGE challenge that would put her on the other side of the job and allow her to see, feel, and hear hospital life from a patient’s point of view. Because Pam was so ill, she had no choice but to be “held captive” until she recovered. I should probably add here that Pam, although not mean or hateful, was a challenge for her doctor, and he remained calm while she was being Pam.

When you are a patient in the hospital where you work, it can feel like “double duty.” Who seriously wants to do 24/7 at their job??? It can be embarrassing, too, because you know most everyone and, of course, when they see you word gets around that you are a patient. You feel like total “crap” and you are given a gown that opens in the back and is rumored to have been created by “Seymour Butts.” You are constantly in the state of “bed head,” and being taken through the hallways for testing can be a big deal when you don’t want to be recognized. The pillow case over the head trick was a bit too ridiculous even for Pam and at first she was so sick that she really didn’t care. Every nurse knows what it’s like to no sooner get a patient cleaned up and they mess themselves. You don’t really think about you ever being the cause of that kind of mess, but it happens. Remember that feeling if it happens to you and think how your patients feel when they cannot help making “a mess.”

When working ICU, Pam was “pretty slick” at the task of inserting nasogastric tubes. She knew it was uncomfortable for the patient and was careful to explain the process before inserting. WELL…during Pam’s stay in the hospital, she had the tube placed SIX times. It was very uncomfortable to say the least. What was learned from this experience is that you MUST secure that tube so that it is not being jerked or tugged on. When there is even the slightest movement in the back of the throat you can feel like you are going to vomit.  Your throat feels like someone has taken a rake to it, and the pain is awful. Remember when ambulating your patient with an NG tube to at all times keep an eye on that tube and make sure it’s not jiggling in the back of your patient’s throat. ALSO, if this is the nurse who is inserting the tube first time or it has been awhile since they have done it, DO NOT discuss the blow-by-blow directions over the patient. It does NOT make your patient feel secure in your ability!!! Be sure to ask the doctor for something to spray in the back of the throat to subdue some of the pain…your patient will love you for it if they must keep the tube for any length of time.

If for some reason you find yourself in the position of needing a concentrated IV drip of potassium, believe your patient…it “hurts like hell!” Not only is there a burning sensation, but there is also a throbbing. One trick is to run the drip in with a plain line so the amount of fluid is diluted and you are not getting “smacked down” with the pure drip. Another tactic is to use warm compresses, but the easiest thing to do is follow Pam’s tactic and turn the IV infusion rate down so the pain is bearable. Remember, this is NOT the recommended answer for you but Pam thought her arm was rotting off!!! Her doctor happened to notice that she had decreased the rate from what was ordered and questioned her. In response, Pam asked if he had ever had a potassium drip and the answer was “no.” He was very understanding and knew Pam was a challenge but also knowledgeable. You WILL need a doctor’s order, of course, before adjusting the rate but be sure to frequently assess your patient for discomfort.

After a month in the hospital, both of her arms were black and blue and spots to start an IV or stick for lab work were few. Initially, she had pointed out good places to get access, but it got to the point there were none left. This is another case of do NOT bring in a brand new nurse to try and gain access. Your patient is beyond patience of being stuck and prodded for the “one more time.” Yes, it has to be done, but perhaps it’s time to bring in someone that is very proficient at doing IV’S. Your pride will not be shattered and your patient will bless you for it caring!

Noises, when you are sick, can be particularly annoying particularly when a nurse is listening to them. After all, we hear these sounds in our sleep and are aware of all the noises that are made by IV pumps, monitors, phones, or call bells. As a sick patient, these noises are intensified and not something that is easy for a nurse to shut out. If your patient is very ill and needs to sleep, then you block as much noise as possible. Someone outside their door laughing, carrying on a prolonged conversation or, God forbid, housekeeping is getting ready to wax the floor in their room. Do what you have to do to put a halt to as much noise as possible. It’s NOT that your patient is a crank, they are sick and not themselves and need their rest. YOU ARE THEIR ADVOCATE and you may have to be “the bad guy” in getting the noise quieted.

One more thing, the patient is being taken into the halls for testing and into radiology. Those hallways are cold and so is radiology. Prepare your patient for the trip by piling on the blankets ahead of time. This is YOUR patient, and they may get to radiology and there are no available blankets or radiology may forget to ask if the patient is cold. Your patient may be too shy to speak up. Pam did not have that problem, but she saw many patients laying silently shivering.

Please do not take these points wrong…they are simply pointing out areas that if you’ve never been a patient and end up being one you may experience yourself. Also, they are some things you may not even think about for your patient. Pam had excellent and professional care during her stay in the hospital but she was also to the brink of escape after being there for one whole month…

I hope that some of these points mentioned will open your eyes to the patient’s point of view. If you have never spent an extended length of time being a patient, then good for you; and I hope you never have to go through that experience. But remember, hundreds of patients are treated each year at your hospital and many of them do have extended care needs. Take ownership of your patient and their needs and look beyond and try to imagine yourself laying in that bed.

written by Linda Dawson

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