Second year Pauline Sim has four years experience as a staff nurse, and would like to shed some light on the role of a nurse.
Why did you go into medicine? Did it involve that famous interview response, ‘Because I wanted to make a difference’, or ‘I want to care for people’? And how did you answer the question ‘Why not nursing?’ Did you ever consider nursing as a career, or give any real thought to the role of a nurse?
In the healthcare setting there are so many stereotypical ideas about all the people you will work with. Doctors are the highly intelligent achievers with poor social skills, who spend a lot of time on the golf course. Oh, and they are all men. Nurses are the ditzy, not very bright, tea-drinking, chocolate-eating, bum-wiping girls that all want to be doctors. Sound familiar?
I have experience of 3 years on a medical ward, as well as bank shifts (where I take shifts in other wards and hospitals), plus three years as a student nurse. In the rest of this article I aim to give a little insight into the main aspects of a staff nurse shift and how you can avoid getting off to a bad start with the nursing team.
Jobs of a Nurse
Basic Patient Care:
Every patient gets washed and their bed is changed daily. If they are unable to wash themselves, then nurses work in pairs and carry out bed baths, or by using moving and handling equipment, get them into a shower or bath. Washing patients is about more than keeping them clean. It gives us a chance to observe and maintain skin integrity. Other jobs include positional changes for those unable to move themselves, dealing with incontinence, and answering buzzers (which can be ongoing and persistent). Nursing staff give out three meals a day to every patient, and also feed those patients who are unable to do so themselves.
Tip: Protected meal-times were introduced to wards to combat malnutrition. These protected meal-times should be respected by everyone as there are often no facilities for reheating food (i.e. do not use this time to hold a ward round or send in medical students to practice history taking…the macaroni is no better in a cold congealed mess than it is fresh).
The drug round is notoriously time consuming and important (often >2 hours). It is mostly done in the morning and requires great concentration so if you see a nurse wearing a purple apron or something similar (be aware of local policy) then please do not disturb!
• We are legally not allowed to give a drug if the prescription is illegible, or not written up correctly.
• Lots of questions arise e.g. Should anti-hypertensive drugs be given if patient has a lower than normal blood pressure? Clinical Pharmacists are a great point of contact for these queries.
Tip: By keeping your drug kardexes up to date, you will keep the nursing staff happy.
Observations are recorded by nursing staff throughout their shift. Any changes, causes for concern, or an early warning score above a particular level means we have to inform the medical team. Observations are recorded by nursing staff throughout their shift. Any changes, causes for concern, or an early warning score above a particular level means we have to inform the medical team.
Tip: Nurses may come to you saying, “I’ve just got a feeling something isn’t right”, but only have gut feeling and clinical experience to support this. Remember that nurses spend a lot of time with their patients and they get to know them in a way that the medical staff don’t. At these times, all we want is for you not to dismiss our concerns, and review the patient for us.
Practical jobs include giving intravenous fluids and courses of immunoglobulins, dressing wounds, and assisting the medical staff with procedures such as lumbar punctures. We also talk to patients and their relatives, and attend the ward round and multidisciplinary meetings. Nurses have to complete a fair share of paperwork too: an admission pack for every patient admitted, updating care plans daily, writing up nursing notes for the patients in their team, and keeping charts up to date.
Forget about them vs us…
It is very easy to fall into the “them and us” mind set, and yes, it does work both ways. We should provide all our colleagues with mutual respect, if they are a doctor, nurse, physiotherapist or domestic. We should all be able to coexist; after all, we are all there with the same goal that is to look after our patients to the best of our capabilities. Nurses need to accept that they don’t have exclusive rights to the chocolates, however doctors shouldn’t just pop up out of nowhere and steal them! If we all make an effort and share the chocolates, then the world will be a happy and peaceful place!
Getting Off to a Good Start with Nurses
•Talk to the nurses –communication is key to an efficient working environment. It is always good manners to introduce yourself to them and ask before approaching patients. Of course in any profession there are always people who are rude and unwelcoming – try not to let a negative experience form your opinion for the whole profession.
• If you want to know how a patient is, try asking the nurse that has been looking after that specific patient all day. They will know better than the charge nurse or the first nurse you happen to find in the ward.
• When you are carrying out a routine procedure such as cannulation or venepuncture, please tidy up after yourself and try not to get blood all over the patient!
• When admitting a patient from home, think carefully before bringing them in on a Friday afternoon. Nothing will happen over the weekend, causing frustration to the patient and their relatives. This gets taken out on the nursing staff or the on call doctor covering the ward.
• When discharging a patient, please speak to the relevant nurse. It looks unprofessional when the nurses are told by the patient that they are being discharged.
• Try not to make any promises about time of discharge, as there are factors that you need to consider first, most importantly discharge drugs – the pharmacy closes at 5pm and if a discharge script does not reach them on time then the patient cannot get home that day.
• When speaking to patients about sensitive matters, please try to take the patient to a private room where possible. Curtains do not protect verbal privacy.
• When breaking bad news, ask a nurse to accompany you or, if this is not possible, tell the nurse exactly what you have told the patient. This ensures that the nurses can fully support the patient and provide the necessary translation once the doctor has left. Patients have a tendency to “smile and nod” to the doctor but once alone with the nurse confess to not understanding anything, or having questions that they did not want to bother the doctor with. It helps us to know that we are reiterating the same information to the patient.