Wednesday, January 7, 2009

The Best Nurse I've Ever Had

By no means am I the most experienced nurse around.  I graduated in 2007 and I've only been an ER nurse for a year.

I'm certainly not the most knowledgable nurse I know.  In fact, I've tagged a few nurses in my ER that I can go to when I have a "what on earth was that" moment.  They usually know the answers and keep me in line.

I'm not the fastest nurse around.  In fact, sometimes I can be pretty slow because I still second-guess myself (was I supposed to mix that with bacteriostatic water or saline?) and when setting up for procedures I can never seem to remember all the supplies (oh yeah, I guess a speculum would have helped for the pelvic set up).  I've been making efforts to keep my secondary exams focused, but my OCD self just can't leave that height and weight box empty even though my patient is here for a stubbed toe.

I really can't say that I never make mistakes.  Sometimes I look at a chart after a patient has left and think, "I hope the lawyer doesn't see that."  I forget to go and get the cup of ice and the extra blanket that I promised.  I treat a patient for three hours before realizing that they don't have a name band and I've given several medications.  I miss more than my share of IV sticks.  I almost always show up 1 minute late no matter what I do.  To save my life I can't remember the name of the patient in room 23.  I had a nurse ask me if I had charted the black eye on that patient who just got shipped to the level 1 hospital... I hadn't even noticed it.

So why is it, then, that I have had many patients say to me: "you are the best nurse I've ever had"? don't say this to brag - if I wanted to brag I wouldn't admit to all that stuff up above - but because I think that maybe I've found my nursing superpower: empathy.

I care about my patients.  Yes I get frustrated with the patient who is here for the third time this week for chronic back pain, but I can still go in the room, listen to their story, hold their hand, and be polite when I tell them that all they are getting is ibuprofen.

The other day I had a patient in for a migraine headache, so I went through the standard migraine fare: IV, Toradol, Benadryl, Compazine, lights off, rest for an hour.  Somewhere along the way a question I asked her raised a red flag so I dug deeper and found a history of drug problems and concerns about her children and problems with stress.  I sat at her bedside for a few minutes and offered some words of encouragement, I found the social worker and asked her to go talk to the patient, and I followed up a while later to make sure that everything was taken care of.  We talked for a little bit and hammered out a list of goals for the patient to work on to get life back on track.  When we were done she said, "every time I've ever come to the ER, everyone just rushes in and out like I don't exist.  Thank you for treating me like a person."  Another guy the same day came in with a University of Texas sweater on, so while I was starting the IV, I chatted with him about who would win the OSU-Texas game and what he thought of USC's defense.  He thought I was an angel.  A few months ago I had a patient who was a little rude, but I did my best to treat her well and to carefully explain the doctor's decision to not give her narcotics.  She got mad and came out of her room and started swearing and yelling and security was called.  Somehow I talked her down and managed to escort her and her threats of lawsuits out before security got there, but I felt like a failure to have had so angry and difficult of a patient.  When I got back, the charge nurse pulled me aside and told me that the patient was a very frequent flier (I hadn't met her before) and this was the calmest and best behaved anyone had ever seen her.  No less than 4 nurses stopped to congratulate me on how well I had handled her.

I really didn't do anything special.  I don't have to.  I have found that when it all comes down to it, most of the patients I see don't want a nurse who can recite the top ten side effects of venlafaxine.  They want a nurse who validates them as a human.

I'm not trying to belittle the technical skills and knowledge that are required to be a successful ER nurse.  A satisfied dead patient is still dead.  And I love the rush of working as a team to save a sinking patient, the satisfaction of getting a patient off to the cath lab to stop the heart attack, and the challenge of determining the correct rate of complicated medications.  I'm trying hard to become the best I can at starting IV lines, accessing ports, inserting catheters, remembering which medications are compatible, remembering to chart everything that the lawyers want me to write, and catching the subtle but important clues when assessing patients.  I have a long ways to go, and I get frustrated and anxious and overwhelmed and a little bit mad at the drunk who is running around in his underwear.  And if I could make an honest list from among the nurses in my ER of who I would want working on me when my heart stops beating, I'm not sure that I would be in the top 10.

I'm nowhere near a perfect nurse, but I am a good nurse, and my patients love me.  I certainly do not have the market cornered on being a "best nurse", nor do I want to.  My point is not to lift myself up.  My point is to say that anybody can be a supernurse.  Next time you go to work, take just an extra minute to tell a joke, hold a hand, offer a hug, ask the kid when his birthday is, put that necklace in a baggie so it doesn't get lost, and stop by the ICU after your shift to see how your patient is doing.  Not only will it make your patients much happier, it will reflect well on your facility, and it will make your job feel so much more rewarding when that patient looks at you and says, "You're the best nurse I've ever had."


Braden said...

I went back and forth for a long time about this post before finally deciding to publish it. I hope that you will take it in the spirit in which I offer it and not as a testament to my arrogance. Those who know me well know that I am not overly confident or full of myself - quite the opposite, really. In fact, I'm always surprised that my simple actions so frequently merit the laud and honor that patients give me.

Try it, you'll see.

Ambulance Mommy said...


I had a very bad experience in an ER a few weeks ago, and when I got mad, I posted a rather sarcastic post about it. But at the end of the day, if I had to wait for 4 to 5 hours, I wouldn't have minded if someone had just acknowledged me as a person, that I was in pain, that they were sorry I had to wait. I don't necessarily need my caretakers to be perfect, I would rather they have compassion and know when to ask for help if they don't know the answer. So I think your post is's not always the most knowledgeable people that I have the best experience with, it tends to be the most caring, and the most willing to admit when they need help.


Bit By Bit said...

A minute or two to explain what is going on, and a kind word does make an overwhelming situation just a little more bearable.

At least that is what my husband and I discovered when our newborn ended up in the ER and ultimately the NICU. We are forever grateful for the patience and kindness of particular doctors and nurses. When the dust settled, we let them know too.

Keep it up!

Tony said...

Don't apologize...Just keep up the great work

Nurse K said...

It's good to be chatty when you're like pushing meds or it's not busy or something but the other nurses will hate you if all you do is chat when they're picking up your slack...Fair warning. All the chatty nurses are pretty much universally hated by the staff but the patients love them.

Personal pet peeve are nurses who chit-chat with the patients in triage while I'm hammering through the slips. One nurse busts out pictures of her dogs for shitsakes. In triage!!!!!!

EDNurseasauras said...

I can't say I'm the best at anything except maybe hangning in there as a clinical ER nurse for 32 years. At the end of the day, if a patient even says "thank you for being so caring" I'm good.

Mary said...

This is something I have encountered many many times through my rotations...and empathy makes the biggest difference, and doesn't take much of your time.

Leona said...

I agree with Tony: don't apologize, just keep it up. And don't worry about the "chatty nurses" comment. I don't know you but I doubt you are so chatty that it causes a delay in care or SIGNIFICANTLY long triage times. We have a couple of them, too, and we all admit: they give GREAT care, their pts love them. Also, my husband, who is an LVN with no ER experience, could have written your post. I have been an RN for 18 yrs, an LVN for 5 yrs before that, have 15+ yrs of critical care experience not including the last 2 in the ER, and I admire and look up to him. I think I would you, too, if we were co-workers. Thanks for your post.

Unknown said...

Keep it up indeed! If everyone did what you do - this simple act - we would have better health care and better shifts in an instant. Because we all began this journey to connect with people.

I am just a lowly school nurse right now - but I bring out pics of my shitzu often. Seeing that cute dog will help calm down a kid, stop the tears/sobbing and allow me to assess the true picture - not the physical pic emotions have created. Maybe your coworker shows off her dog for the same reason. Just as we learned way back when - we are assessing and triaging ALL the time.

Unknown said...

As an RN for 30 years I have to say you hit the nail on the head. I've never, ever become too busy to see the person in the patient. There is a huge difference between being chatty and being empathetic. There are many skilled, intelligent people who become nurses because it's a great job. The best nurses are the people who become nurses because it's who they are. And their caring extends to their coworkers as well. I'm still excited to share my knowledge and passion with younger nurses and to praise the accomplishments of other nurses. Keep up the great work and keep learning and pass it on!!