Sunday, January 15, 2012

The Most Glorious Words

Yesterday I heard the most glorious words from a doctor at work.

Our morning started out with several conversations like this:

1.) PICU Nurse: The patient has been in this position for a really long time. I know that he doesn't really tolerate turning well, but I'd like to take him off the oscillator, suction him, and try to reposition him- it's been awhile since all that has happened. I can get a few other nurses and a respiratory therapist in here to help out. What do you think?

Dr Red (he doesn't wear red, doesn't have red hair, I don't know...just the first thing to come to mind!): Well, I think we should hold off. I'm not sure that we should suction him today. Maybe tomorrow.

PICU Nurse: Well, if he has more desaturations, I'd like to re-consider it.

Dr Red: Umm, ok

*And yes, the "umm ok" was REAL convincing!

2.) a few hours later:
PICU Nurse: The patient's blood pressure is really low. I know that we ordered dopamine for him, but that may take a bit to get from pharmacy. Do you want me to give a little bolus?

Dr Red: Well, I don't think we should give fluid. He's on a lasix drip and may be fluid overloaded.

*The attending physician was standing by overhearing our conversation. She then replied "Nope, we definitely need to give this kid a bolus. Get those pressures up!"

3.) about 45 minutes later I page the doc-
PICU Nurse: My vanco trough just came back really high at 47. I currently have the vanco running. Do you want me to stop the dose and repeat a trough in a few hours?

Dr Red: No, usually pharmacy wants us to complete the dose given immediately after the trough is drawn. We can just re-check a level tonight.

**3 minutes later Dr Red calls PICU Nurse

Dr Red: OK, so I just talked with pharmacy and they want you to stop the vanco. And if you could re-check a trough in two hours, that would be great.

PICU Nurse: OK, no problem.

*Just as I was getting ready to hang up the phone, Dr Red adds "Ohh, and I guess I'm done saying no and second guessing you. Everything I've shot down from you today has been the right call. So whatever else you think would benefit this patient, just let me know."

Oh yes! The most glorious words ever!!

No more second guessing and just trusting us bedside nurses!

Score for PICU nurse!

I think it not only validated that I am a good bedside nurse, but that I am ready to move onto being an APN (aghh, did I just say that...scary!). That I can think about the "tasky" things as a nurse, and that I can think about the direction that we should go in.

So it was a good day. A day that I was able to be the bedside nurse that I know to be, and also step up a bit and help coordinate care more.

But what was most glorious about this, was that it was validated. By Dr Red, by the attending physician overhearing our conversation, and by the entire team.

And this just goes to show you that there truly IS power in words. Glorious, glorious words!

1 comment:

  1. I was not at all surprised to read your account of you teaching the doctor, but very very proud of you...that would be a yes!