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This is a story I often tell to my students to explain to them the kind of nurse NOT to be. It is a true story of a new RN grad I worked with in California who was in part my inspiration to become a nurse educator . . . so I could teach people NOT to be her. It's a CoCW kind of story.
I worked in a medium sized Level 3 trauma center in Northern California about 10 years ago. We had about 25 beds, and were constantly busy. Our hospital was in a rural area about 1 1/2 hrs from the nearest large city (Sacramento). At that time, California was struggling with a major nursing shortage, and so many hospitals had adopted the practice of hiring new RN grads to work in specialty units (when I first became a nurse, you had to work a minimum of one year on a med surg unit before they'd even consider you).
Kristen was one such new grad.
One day, while Kristen was still in orientation, I walked into the med room to find her attempting to draw some 2% lidocaine solution into a syringe. She was cussing up a blue streak.
Me: What's wrong, Kristen?
Kristen: I can't get the medicine out of the vial.
Me:
*trying to think of why that would be* Did you put air into it? (note to the reader: to get fluid out of a vial, you have to put an amount of air in equal to what you are taking out )
Kristen: Everyone knows they teach you stuff in nursing school that you never use.
Me:
Oh. Ah. Well. Well, there's some truth to that. There's lots of stuff my instructors taught me and I don't always do it quite that way anymore. But I think you should work for awhile before you decide what to keep and what to throw away. Put some air in the vial . . . you'll get the medicine out.
Two years later, and she never got any better. The doctors hated her because she did everything by rote . . . no critical thinking or planning to prevent problems or complications. The nurses hated her because you couldn't tell her anything . . . she knew it all.
One day one of our frequent flyers came in with a fever. She was truly sick (for a change). The doctor suspected a urinal tract infection, and wanted a sterile specimen because the patient was on her period. Kristen was her nurse.
Kristen came to me to ask for assistance getting the urine specimen. The patient was morbidly obese (450 lbs if an ounce); she needed someone to hold the fat folds away from the perineum so Kristen could see what she was doing. It was a legit request, and I was not busy so I readily agreed.
I go into the room and chat with the patient while I wait for Kristen to get her equipment. She comes in with a fem cath kit. A fem cath kit is a short, plastic catheter, 8 french diameter, pre-attached to a test tube. We use them routinely for obtaining this kind of specimen . . . on normal sized people.
Me:
What's that?
Kristen: a fem cath
Me: You're going to use that? On her?
Kristen: *visibly annoyed* Yes.
Me: hoookay . . .
So I pull the abdomen away from the perineum while Kristen tries to get the cath in. In short order she begins grunting and muttering under her breath. The perineum was so deep, she couldn't get the cath in to get the sample. The patient was clearly uncomfortable.
Me: OK, Kristen, stop. Let me try it.
Kristen: *frustrated* OK
So I go and get a foley cath kit. A foley is a long, rubber catheter with 2 lumens: one drains the urine. The other ends at the tip in a balloon filled with saline to keep the catheter in the bladder. It is connected to a bag that hangs on the bed for long term drainage of urine.
Kristen: You're using that?
Me: Yes. *I put the foley in in less than a minute and hung the bag on the bed* There you go. Now you can get your sample.
Kristen: You're leaving it in?
Me: Yes.
Kristen: We don't have an order for that.
Me: That's not a problem. I'll get the doc to write one.
Kristen: But we only needed it for the urine sample.
Me: Kristen, do you want to have to help this lady off this bed, and walk her down the hallway when she needs to go to the bathroom? Or put her on a bed pan? Dee? Do you want to have to walk to the bathroom, or use a bed pan?
Dee (the patient): Oh, no, Panacea! I'd rather you left the catheter in, please!
And this, folks, is why I decided to become a nursing instructor. I wanted to train the kind of people *I* would want to work with!
I know some of you have had real horror stories with nurses when you've been in the health care system. I'm trying really hard to teach new nurses not to be like that with stories like this.
I worked in a medium sized Level 3 trauma center in Northern California about 10 years ago. We had about 25 beds, and were constantly busy. Our hospital was in a rural area about 1 1/2 hrs from the nearest large city (Sacramento). At that time, California was struggling with a major nursing shortage, and so many hospitals had adopted the practice of hiring new RN grads to work in specialty units (when I first became a nurse, you had to work a minimum of one year on a med surg unit before they'd even consider you).
Kristen was one such new grad.
One day, while Kristen was still in orientation, I walked into the med room to find her attempting to draw some 2% lidocaine solution into a syringe. She was cussing up a blue streak.
Me: What's wrong, Kristen?
Kristen: I can't get the medicine out of the vial.
Me:
*trying to think of why that would be* Did you put air into it? (note to the reader: to get fluid out of a vial, you have to put an amount of air in equal to what you are taking out )Kristen: Everyone knows they teach you stuff in nursing school that you never use.
Me:
Oh. Ah. Well. Well, there's some truth to that. There's lots of stuff my instructors taught me and I don't always do it quite that way anymore. But I think you should work for awhile before you decide what to keep and what to throw away. Put some air in the vial . . . you'll get the medicine out.Two years later, and she never got any better. The doctors hated her because she did everything by rote . . . no critical thinking or planning to prevent problems or complications. The nurses hated her because you couldn't tell her anything . . . she knew it all.
One day one of our frequent flyers came in with a fever. She was truly sick (for a change). The doctor suspected a urinal tract infection, and wanted a sterile specimen because the patient was on her period. Kristen was her nurse.
Kristen came to me to ask for assistance getting the urine specimen. The patient was morbidly obese (450 lbs if an ounce); she needed someone to hold the fat folds away from the perineum so Kristen could see what she was doing. It was a legit request, and I was not busy so I readily agreed.
I go into the room and chat with the patient while I wait for Kristen to get her equipment. She comes in with a fem cath kit. A fem cath kit is a short, plastic catheter, 8 french diameter, pre-attached to a test tube. We use them routinely for obtaining this kind of specimen . . . on normal sized people.
Me:
What's that?Kristen: a fem cath
Me: You're going to use that? On her?
Kristen: *visibly annoyed* Yes.
Me: hoookay . . .
So I pull the abdomen away from the perineum while Kristen tries to get the cath in. In short order she begins grunting and muttering under her breath. The perineum was so deep, she couldn't get the cath in to get the sample. The patient was clearly uncomfortable.
Me: OK, Kristen, stop. Let me try it.
Kristen: *frustrated* OK
So I go and get a foley cath kit. A foley is a long, rubber catheter with 2 lumens: one drains the urine. The other ends at the tip in a balloon filled with saline to keep the catheter in the bladder. It is connected to a bag that hangs on the bed for long term drainage of urine.
Kristen: You're using that?
Me: Yes. *I put the foley in in less than a minute and hung the bag on the bed* There you go. Now you can get your sample.
Kristen: You're leaving it in?
Me: Yes.
Kristen: We don't have an order for that.
Me: That's not a problem. I'll get the doc to write one.
Kristen: But we only needed it for the urine sample.
Me: Kristen, do you want to have to help this lady off this bed, and walk her down the hallway when she needs to go to the bathroom? Or put her on a bed pan? Dee? Do you want to have to walk to the bathroom, or use a bed pan?
Dee (the patient): Oh, no, Panacea! I'd rather you left the catheter in, please!
And this, folks, is why I decided to become a nursing instructor. I wanted to train the kind of people *I* would want to work with!
I know some of you have had real horror stories with nurses when you've been in the health care system. I'm trying really hard to teach new nurses not to be like that with stories like this.
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