Our second installment talks to rehabRN, a rehab nursing specialist who has been actively blogging about it for over four years at RehabRN. Her bio states: “RN living down on the farm with Dahey, Bubba, WildDog and other wild animals, working at the Hotel Rehab to pay the bills and get material for this blog and for my standup comedy routine (if I had the time to do it…maybe when I retire!)…Hope you enjoy this dramatization of my little world. Finally, say thank you to your favorite nurses, ’cause we not only wipe you, we also just might have to save you, and we do it with a smile 24/7.”
The bold statements are taken directly from her posted works, followed by our questions and her responses.
One of our long-time people decided to become a DNR this week after much discussion with the medical staff. We’ll see what happens next. Convincing a patient that a DNR is in their best interests cannot be an easy task – what are some of the things you have learned as a nurse that help a patient to see their condition from enough distance to make a call like this with less emotion?
Many patients with long-term illnesses or debilitating conditions don’t have a lot of control over some things in life, but choosing their code status, is for many, a choice. Some are confident they have family members who will honor their wishes; others do not. Some people think if you make a choice, like choosing to be a no code, that you are choosing death, pain and suffering. Some people don’t realize that being a full code can be a lot of pain and suffering.
I feel strongly that people of sound mind should choose. It is my job to advocate for them by giving them as much information in a non-threatening, non-judgmental way for them to make a decision.
In a way, I feel like a nurse has a lot in common with many tradesmen. I had to apprentice and learn and then go out as a journeyman (or person as you wish) and ply my trade. Everything I learn colors what I do, and I don’t look at things the same anymore. Do specific moments have to be very pronounced to have this kind of influence – to “color” what you will do after it happens, or are some things simply absorbed slowly over time? In viewing things differently today, do you see your new perspective as a plus, a hurdle, or balanced in-between?
A lot of what nurses do is learned tasks and psychomotor skills. This can take time to learn. Some skills people pick up quickly. Putting the physical skills and the mental skills together and synthesizing it all is what makes a good nurse great.
What we do as nurses is immediate and visible in our practice and the lives of our patients, even if we don’t see it directly. This is why I really enjoy rehab, since we see this happen literally right before our eyes. Would you consider exploring other areas of care based on this feeling of direct results (such as ER), or does rehab nursing fulfill you both personally and professionally?
Having worked in rehab for over four years, and knowing what I know from others, I would not do any other type of nursing. There are so many facets to what I can do as a certified rehab nurse, from direct patient care, to case management, to management and education, that I feel as if I can go down many paths and still be a rehab nurse at heart. I enjoy having long-term relationships with patients and in a large facility, I can practice in many roles.
And at this point in time, I can’t imagine doing anything else. At other points and times, what are the factors that could make you start to question your decision? How firm is nursing in the definition of your character, and how specific is that definition?
What has made me question what I do? Working with people who see work as a “job” or a “paycheck”. I see nursing as a vocation of caring and service.
I’m dreaming of passing my certification and GRE exams before summer, since after that, it will be a long time before I get any more vacation. However, I do believe that we need to dream. It keeps you going. What are the best dreams of a rehab nurse these days?
I dream of using new tools to help my patients and my fellow staff members. I am a technical person from my previous life and I have always been interested in doing things different ways to see what will happen.
In my wildest dreams, I dream of cures for paralysis and injury, but I live in the reality that even if we never get there in my lifetime, working to make life better for people is not a bad thing at all.
…you second-guess if you did the right thing for the patient that died. Did I miss some signs they had or were there so many problems which could mask another, that I couldn’t keep them straight? You find out that you weren’t the only nurse to wonder…and maybe the MDs are pissed because they couldn’t see any signs, either. It seems to me, completely removed from the situations described, that nurses with concerns would be voicing them. Is this not the case in most situations? What helps a nurse to be able to express themselves more openly and which factors have you experienced getting in the way?
Sometimes, as noted in literature, nurses are bullied and do not speak up. I can tell you that I have felt this way often. I have also learned, however, ways to navigate around the systems that might thwart me in my job. First, I follow the number one nursing rule and go through the chain of command. I tell my boss what we need and I document it. If I can’t get what I want from my boss, I ask to advance, and with permission, I continue.
I’ll either get shot down as an upstart, or I will keep going until I get to the top (usually someone in between can help).
I’m not too afraid of bodily fluids, but vomit gets me. Everything else–nasty, draining wounds, poop, etc., rarely faze me. It’s that rascally vomit that is my Kryptonite. Everyone has their Kryptonite, but an emergency situation requires a cape – not cowering. How do you get past personal hang-ups and things that are simply yucky to be able to provide the best possible care to your patients? Any tips for maintaining professionalism when you are about to hurl?
Very simply: fake it until you make it. I’m not the world’s greatest actress, but I surely try! I learned early on as a mother that if you model calm behavior, kids will be calm. The same applies with adults: if you get frazzled, people will get frazzled with you.
How do you maintain professionalism while you hurl: Excuse yourself and hurl somewhere out of sight. Apologize profusely, and then take care of your patient as if nothing happened.
It never bothered me if a foodservice person wasn’t wearing gloves before, but it really does now. I found it interesting to see the number of nurses who talk about hand washing and fears of germ-passing. Have your nursing habits and observations traveled over to your family life? What, besides germs, have you done to try to make sure they are protected as much as possible?
Somewhat. I try to be lenient, but I will wear a mask at home if I’m taking care of a sick kid and I will be cleaning all the doorknobs once someone gets a cold. Besides, it’s all about hand hygiene, don’t share food or drinks if you even think you’re sick and sleep in another room if your spouse is ill with something contagious. Thankfully, I have a very comfy living room couch!
I’m now fluent in several types of wheelchair drive systems. Would you recommend that a nursing student interested in rehab work become familiar with the mechanics of it all – or does the technology move fast, so they might be better-off concentrating on it when they are more actively involved with it? To clarify: is there going to be clear benefits in learning the hardware ahead of time? And if so, where would a student be able to learn about these things?
Technology changes quickly so get used to that. Your best friends when learning about wheelchairs and other equipment are the therapists. They can teach you a lot, as well as reading the manuals if you have them. If not, go online and look them up.
The docs are impressed that I read notes. I talked to one of the residents running around with the doc there and they were talking about someone’s recent surgery. I told them what I knew about it, asked a couple of questions and got a quick 101 from the specialist. They seemed impressed that I knew what type of surgery it was. What other things about the way you work has made an impression on those around you? In other words, what are the traits to strive for as a nursing student looking to “fit in” and perhaps make a difference in their environment?
Realize that some people like nurses and some don’t. Some people like to talk about their jobs and some don’t. I have found that many people like you to ask about something that may be a specialty, especially doctors.
You may feel others still have the “high school mentality” that you can’t talk to certain people, including doctors, but I don’t believe it. If you’re uncomfortable talking to the docs while they’re at the nurses’ station using the computers, talk to them on rounds. One of our specialists liked to tell stories, so I learned quite a bit about him and his practice by talking to him on rounds. He liked to share information, and was known throughout the medical school as a great doc to work with. Some of our nurses did not like him, and looked down on people who talked to him because they said you were a “brown nose” if you talked to him. Talking to him on rounds eliminated this behavior because the bullies were never nearby.
You really must have a strong constitution to be a nurse of any kind. Remember that, and don’t be too hard on yourself. Self-care is the most important thing a new nurse can learn. If you don’t, you’ll burn out quickly.
Thanks for sharing your insight and experiences, rehabRN! You can read more work by rehabRN on her blog: RehabRN
Tune-in tomorrow as we talk to Keith Carlson to delve a bit deeper into some of the emotional and spiritual questions facing today’s emerging nursing students.