Jess Morton has just celebrated 10 years since her first registration as an Enrolled Nurse. Here she reflects on the lessons learnt…
Ten years ago today, I walked into the NSW Nursing Board office as a bright-eyed, all-keen, newly graduated, 19 year old. I then officially walked out as a nurse.
It is surreal to reflect on the things I have seen, the things I have done and, more so, what I have learnt. I have held the hands of and watched countless people die. I have been the one to make a phone call to inform a daughter at 2am that her beloved mother had just passed away.
I have heard the shrill scream of a mum when her nine month old baby arrested in front of her. I have taken that baby and hit the button and watched as a team swooped in and worked calmly but quickly until their breath returned.
Doctors who I have worked with have progressed from residents to senior registrars, then they have gleefully placed epidurals in my spine as I screamed at them in labour.
I have sustained a needlestick and been in harm’s way. I have seen how a clot can end a life and I have peeled back the sheets to find a very new and a very young mum haemorrhaging out whilst a fist compresses her uterus.
I have nursed the very young and the very old. But what has it all taught me? What have I actually learnt in 10 years of nursing?
Well, here it is:
Life is short! It is a cliche, I do realise this. Life was short for the three year old who contracted meningitis. Like it was too short for my friend the medical resident who died suddenly in his sleep, before starting his night shift. While we see many controlled and palliated deaths, we also see many that end abruptly without warning.
Vaccinations save lives. When your elderly patients, who were once nurses in their youth, tell you about their day of caring for children with polio, who lived attached to their iron lung, it is then you truly appreciate how different our landscape of nursing is. I appreciate that parents have done their .com research, but I have watched a six month old innocently try to breathe as their immature respiratory system battles whooping cough. Please vaccinate your children.
Hospitals are over-paracetamolised. That’s it. It is all I have to say. We give out crazy amounts of paracetamol.
The assessment of pain. Making the assessment that your patient is not in pain because they are asleep is not evidence-based or fair. People manage pain differently. Denying a patient a medical review for their pain because you have seen them asleep or still talking to their family is wrong.
We need to always keep educating ourselves. This isn’t just about completing the minimum hours of CPD required to fulfil AHPRA regulations. It is about continually questioning what we do in our practice and why we do it. Have you recently checked the research on whether the trendelenburg position is actually proven to be beneficial for the immediate management for hypotension? (I’ve included some interesting references at the bottom, check out the research for yourself). Yet so many still rush to do it.
We need to question our practise, just like we would question a drug order if we thought it was wrong.
“Under pressure, you don’t rise to the occasion, you sink to the level of your training”. Make your training count!
Mistakes happen. No one wants them to. There are a multitude of forms, checklists and protocols designed to prevent or minimise errors and critical incidents. The Garling report (2008) outlined many recommendations as part of a special commission inquiry into the acute care services within NSW hospitals. You may have seen some of the outcomes of the inquiry, such as “between the flags” observations charts. What we don’t don’t do a checklist for at the start of our shift is the acknowledgement of the role of human factors in our practice. Situational awareness and human behaviour are two parts of this. We need to to be aware of these to be safer practitioners.
“Human factors research applies knowledge about human strengths and limitations to the design of interactive systems of people, equipment and their environment to ensure their effectiveness, safety and ease of use.” Henrickson et al (2008).
Prepare an Advanced Care Directive. Modern medicine truly is a miracle. Every day we see the results of these miracles. However, there are too many occasions when we see the full force of medicine used for patients who we may believe it is futile to treat in that way.
We see the lady with dementia in her 90s receiving every CT and blood test. Did the man in his 60s who must have known his lungs would slowly fail when he lives on home O2 due to his COPD and has now been tubed and taken to ICU, did he really want that? Had anyone ever discussed potential outcomes if he were to acutely deteriorate?
You need to read this excellent article from Dr Ash Witt, medical registrar and a future geriatrician. Then, it is time to start preparing an advanced care directive. Make your own decisions now, so that your poor family don’t have to do it at 2am when you are unable to do it yourself.
Politics. Many things have changed in the past 10 years. Practise, equipment, policies and thankfully the use of those horrible drawsheets and plastic (in my place of work at least). However some things just…do…not..change!
Many of these are just politics. Whether it’s politics from management or from government, there are many things we will never understand. They can always be dismissed with a ‘humph’ and an exasperated “Politics!”
Look out for each other. Nursing can be a stressful job. Stress comes in many forms and from many causes. It may be the workload, it may be the patients or their family or bullying or a critical incident. We all deal with stress differently. But the one thing I think we could do better is look out for each other.
To truly understand, you need to lie in that bed. It is only from my experience of being a hospital inpatient for two months that I truly began to understand how many of my patients have felt.
Have you ever tried to pee on a pan? It is ridiculously hard. Have you ever woken from an anaesthetic and heard the nurses above you talking about you as though you are not there? You just want to go back to sleep and not wake up until they have gone. Being that inpatient will forever change how I nurse.
Introduce yourself. It was when Dr Kate Granger became a patient while dealing with post-operative sepsis and terminal cancer that she found no one introduced themselves or their role before delivering care. It was there that the #HelloMyNameIs campaign started.
I found it hard to comprehend that it was more uncommon than common for nursing staff to show such basic courtesy. But when I became a patient, I found myself in the same situation. In the first few days of being an inpatient, not one nurse or doctor introduced themselves. At the start of each shift, no one came around and stated they were my nurse. It makes a big difference when you are feeling unwell and vulnerable to be aware who is responsible for your care.
End the tribalism. No matter where you work in the hospital, the community, the nursing home or elsewhere, you are all intelligent hard workers. Whether you are the ED nurse who doesn’t know anything about the patient you just got asked to transfer as you have four of your own acute patients and you have just come out of helping in resus, or you are the ward nurse trying to manage chest pain, a falls-risk patient who is wandering and running late with the dinner insulins… You are all good at your job. Be a team, don’t pay out on each other.
Dr Vic Brazil, an Emergency consultant gave this stand out talk at the SMACC conference on the Gold coast in 2014 about tribalism in medicine. It is just as applicable to nursing.
Keep going. When you have a crappy shift or a crappy week or a crappy winter, talk to each other!
Organise a work night out or bake cookies for work. Do something to help the morale of all, take a big breath … and keep going!
I wonder what the next 10 years will teach me…
Also by Jess Morton on Nurse Uncut: Casual nurse and proud of it
- Fryer, L. Human factors in nursing: The time is now. Australian Journal Of Advanced Nursing, 30(2).
- Garling, P. (2008). Final Report of the Special Commission of Inquiry Acute Care Services in NSW Public Hospitals. Sydney: State of NSW
- The Trendelenburg position improves circulation in cases of shock. Canadian Journal of Emergency Medicine.
- The Trendelenburg position