Nurses:  Thankful Every Shift

Nurses: Thankful Every Shift

NURSES_

It’s that time of year where everyone starts to think of things they’re thankful for and talks about them on social media. Nurses however… we are a different bunch. Every time we go into work, we are thankful. It doesn’t take the month of November to inspire this.

We are not thankful for our massive salaries or bonuses. We are not thankful for predictable jobs where we are guaranteed to finish an entire cup of coffee or get at least two bathroom breaks. We are not thankful for having every holiday off with our families. When nurses think about what they are thankful for, our list looks very different than most peoples’…

We are thankful that we are able to walk, talk, and breathe on our own

We have seen exactly what it looks like when someone suddenly loses those abilities. We have seen the tears stream down patient’s faces, as they are unable to verbalize their feelings. They let their tears fall for their nurses because they don’t want their families to see them struggling.

We are thankful we have jobs with sick time

We see patient after patient come in jobless that has waited until the very last second to come in to have their ailment treated because they cannot afford to pay anything or take time away from work. They wait and pray at home for things to just go away as they become exponentially worse. The man with the pain in his foot three months ago is now having it amputated. The woman with untreated diabetes whose vision was getting blurry earlier this year is now blind. The young mother of four with a respiratory infection that she hoped would go away on its own because she couldn’t take any time off… who is now intubated and sedated in the ICU, in acute respiratory distress syndrome… whose fingers and toes are starting to turn blue and purple from all of the medications she’s getting just to keep her blood pressure up… who is now a DNR.

We are thankful for and constantly in awe of medical advancements

The concert pianist who came in with a stroke and was unable to speak at all – received tPA; and after a few hours of being distraught and unable to communicate all of a sudden can speak as clear as a bell and cannot stop crying out of joy. The 55-year old dad and construction worker who went down at work, but because of his coworkers immediately starting CPR, a hypothermia protocol, and a quick acting medical team and nursing staff in the emergency department/cardiac intensive care unit, he will be able to see his daughter graduate from college. The man who is severely depressed because he has been unable to stop hiccupping for seven years has an operation and sleeps through the night for the first time because they’re finally gone. A few nurses have walked in on him crying with a smile on his face.

We are thankful for our friends, families, and support systems

We see patients come in with no loved ones, no friends, or wards of the state. Shift after shift goes by and no one comes to see them. It breaks our hearts. We spend extra time in their rooms. Give them extra care. We try not to think about their loneliness at home because it hurts too much.

We are thankful for justice and righteousness

We are thankful when we see a physician have a tough but necessary conversation with a family who never sees their loved one and insists on keeping them alive and putting them through painful procedure after painful procedure, even though the medical team has extensively explained that they will not survive or have a meaningful life; or the doctor who stands up to the patient who has been belittling the nurse for the last nine hours; or when abuse is identified and the patient is finally removed from the environment and feels safe at last; or when the nurse practitioner explains to the emotionally absent family of the patient with mental illness exactly what is going on in their loved one’s brain and it finally makes sense to them – and they stop treating them like they need to “just get over it”.

We are thankful for silence

With phones constantly ringing, patients calling out with needs, doctors rounding, pumps beeping, and alarms going off, we are filled with joy when that car door closes and we hear absolutely nothing. It is the sweetest sound.

We are thankful for life

When a normal day at work consists of walking through someone’s worst nightmare, you hug your loved ones a little tighter that night. You cuddle your pets a little longer. You aren’t as quick to be angry. You are keenly aware that it was not your life that just permanently and radically changed – it was the people that you just spent the last 12 hours with, trying to emotionally support them through.

A day in the life of a nurse is a constant and humbling reality check. Sometimes you have to try really hard not to think about how thankful you are in that moment because the sheer emotion from it can take over and you are unable to function. But that is the life we chose, and I wouldn’t change it for anything.

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Explaining MRSA to Your Patient

Explaining MRSA to Your Patient


mrsaimage

With every single shift that I work; there is at least one patient that is on something called contact isolation precautions for MRSA (methicillin-resistant staphylococcus aureus). What is that and why is that necessary, you ask?

Because antibiotics were overprescribed for years, organisms developed that are resistant to the antibiotics that used to work on them. This is why your doctor tells you to make sure you take all of your antibiotics, as prescribed, and not to stop taking them even if you feel better.

Here is an awesome generalized explanation of super bugs and how they came to be.  It’s about 10 minutes, but it’s so good and worth your nursey time!

This presents quite a problem when a patient shows up to the hospital and the antibiotic of choice for their infection won’t work because they’re resistant to it.  Therefore, we need to do as much as possible to prevent the spread of these resistant strains!

Today, most patients are screened for MRSA when admitted to the hospital so that we know who has this specific resistant strain. We don’t want to spread this multi-drug resistant organism from patient to patient as we care for them throughout the day and night.

Keep in mind, there is a difference between an active MRSA infection and a MRSA colonization.

An active MRSA infection means someone has gotten sick because of this bacteria. And you, as the nurse, would know this because it would be part of their admitting diagnosis.

A colonization means that the person is healthy, but carries the bacteria and it can be spread to others.

So when you swab your patient’s nose, send it down to the lab, and 1 hr later they call and say, “Ummm.. yea Mr. Smith in room 872 is MRSA positive,” that means that they have a colonization of MRSA, not an active infection.  Then you have to go put them on contact precautions so they don’t spread this resistant organism to other patients.

Not only can this can be kind of hard to understand as a new nurse, but it is also difficult to explain to the patient and their family as well. This is my basic explanation to someone that comes in and screens positive, and we therefore have to put them on contact isolation precautions. 

“Do you remember when we swabbed you when you came in? Well, what we were testing you for came back positive. What we tested you for was something called MRSA. It’s not an infection; it’s an organism that is resistant to some antibiotics.  This is important for us to know to insure you get the appropriate antibiotics, if they’re needed, and so that we are not passing along this resistant organism to other patients. So, whenever staff members come in, they’re going to be wearing gowns and gloves to protect themselves from passing this along to the other patients that we’re caring for.”

Most hospitals have written patient education that you are required to discuss with them, so make sure you’re following your hospital’s policies and procedures on what to do when someone comes back with a positive MRSA screening.  It has answers to the typical questions (“where did I get this,” “how is it spread,” “will you give me more antibiotics to treat it,” etc.).  And it’s good to give them something written that they can refer to later.

I also tell the family that’s in the room that we’d like them to wear and gown and glove when they’re in the room and make sure they wash their hands. It’s important not to spread it to one another so everyone isn’t acquiring MRSA. Make sure you document your face off when you do your job by educating your patient and family!

 Source: MayoClinic.org

 Some of you may have had patients get CRE (carbapenem-resistant Enterobacteriaceae), a new and terrifying resistant organism.  Here’s a great video explaining this craaazzzy super bug!  I also like that he looks like he’s about to sneeze.  The perfect screen shot.

Why Are Nurses Always On the Computer?!

Why Are Nurses Always On the Computer?!

A nursing student recently emailed me and asked me, “why are nurses always on the computer?” It seemed like a silly question at first, but then I realized that unless you’re responsible for charting on multiple patients (or if you have students or preceptors, making sure it’s accurate), you don’t really understand all that is required.  It’s not like at the end of the shift, you have one big paragraph of information… it’s scattered throughout the chart.

In nursing school, they always teach you the golden rule of nursing.. if it isn’t charted, it isn’t done.

This means that we have to chart absolutely everything.  What does everything entail?  Seriously. Everything.

I decided to mentally go through my charting and let you know what I’m required to chart on for each patient every single shift.  This will slightly vary from hospital to hospital, but not much.

Keep in mind, we have to chart something for all of these. It’s not like if something is normal, we don’t have to say anything.. we have to physically chart something for all things listed below.

Here’s a sample of things we are responsible for charting on one intensive care patient every single shift.

All admission documentation must be done… so if the shift before you didn’t have time or forgot, you need to chart:

  1. The spokesperson/emergency contact and their contact information.
  2. Any acute or chronic pain:  where is it, when did it start, when does it occur, what relieves it, what aggravates it, what medications they take and any other interventions and their response.
  3. Advance directives and information; if they don’t have any you need to chart that you offered it or that they refused.  If they have any advanced directives, you have to obtain them, copy, them, and chart that you did that.
  4. If they have a portable DNR and/or court-appointed guardian; if so you have to obtain it, copy it, put it in the chart, and chart that you did that.
  5. If they brought any belongings with them:  what they are, where they are, and if something was locked with patient relations and the receipt number
  6. If they use any devices at home:  if they use glasses and what distance they use them to see or if they don’t need any, the same with hearing aids, and walking devices, respiratory devices.  If any of those devices were brought to the hospital, you must chart where they are located.
  7. You must chart if they can bathe themselves, toilet themselves, care for themselves.. if not what do they do and who helps them.
  8. Functional mobility screening:  can they walk independently, does someone help them get in and out of bed/their house?
  9. Nutrition screening:  have they lost weight recently, how much, how are they with swallowing/chewing, how is their appetite, etc.?
  10. An Ebola screening as well!  This is typically 2-3 questions.
  11. Do they have any religious beliefs we can address?
  12. We need to offer to call a chaplain or someone for spiritual support.
  13. If the patient requires blood products, we need to know if they consent to that.  If they do not, we need to have them fill out and sign an additional form and flag their chart.
  14. We must chart if they have any cultural needs we can address
  15. We must ask these questions:  Are you safe at home?  Has anyone forced you to have sex?  Has anyone hurt or abused you?
  16. Is this admission related to substance abuse? Do they suffer from chronic pain?  Is this admission related to a suicide attempt?
  17. Where do they live?
  18. Who do they live with?
  19. Do they use any outside resources?
  20. Where will they be discharged to?
  21. Have they ever stopped taking their medications because they can’t pay for them?
  22. Is this a readmission within 30 days?
  23. What medications are they on at home?
  24. What dose, route, medication is it?
  25. When was the last time they took it?
  26. What pharmacy do they use?
  27. Do they have them here?  Where are they right now?
  28. What’s their medical history?
  29. What’s their family’s medical history?
  30. Do they have any medical implants?
  31. Have they ever had MRSA, VRE, c.diff, or currently have an active infection?
  32. Did they get their flu shot this year?
  33. When did they get it?
  34. Do they want one?
  35. Do they screen positive for a pneumococcal vaccine?
  36. Have they ever had one?
  37. When did they have one?
  38. Do they want one?
  39. You need to measure their height and weight (them telling you what it is, you have to measure it)

Now it’s time to start the actual charting…

  1. I have to print and interpret a telemetry strip.  If they have a rhythm change, I need to print and interpret a new one with each new rhythm.
  2. Vital signs (heart rate, blood pressure, respiratory rate, pulse oximetry) every 15 minutes (if stable and not on drips then every 30 min – 1 hour).
  3. Temperature every 4 hours, unless unstable, and source.
  4. Urine output every two hours (unless indicated more frequently), color and consistency.
  5. I have to chart that the telemetry monitor is on and that I reviewed it.
  6. Every time I make a change to the alarm limits, I must chart it.
  7. The patient’s current level of pain at least every four hours.
  8. Any interventions to address their pain and their response within 1 hour.
  9. When I got the report and who I got the report from.
  10. What kind of an assessment I’m doing (first or reassessment).
  11. A Glascow Coma Scale.
  12. The size, shape, and reaction of their pupils.
  13. A complete neurological assessment at least every two hours, unless they change: chart the exceptions to a normal assessment.  If the patient recently received tPA, they get assessed every 15 minutes for a while, then every 3o minutes, then every 1 hour, and finally every 2 hours.
  14. A complete cardiovascular assessment: chart the exceptions to a normal assessment.
  15. The heart monitor is on and the limits are set appropriately.
  16. The current heart rhythm.
  17. A complete respiratory assessment: chart the exceptions to a normal assessment.
  18. Where I am monitoring their SpO2 if it’s continuous or intermittent.
  19. Any supplemental oxygen and device (and appropriate settings).
  20. Bilateral breath sounds.
  21. Every time I complete oral, nasal, or endotracheal suctioning I need to chart the amount, consistency, color, their response, and where it came from.
  22. A complete integumentary assessment: chart the exceptions to a normal assessment.
  23. With each and every wound, abrasion, incision, etc. I have to chart what it looks like, what the area around it looks like, drainage, color, amount, dressing, condition of the dressing, the last time it was changed, the color of the drainage on the dressing.
  24. A complete peripheral vascular assessment: chart the exceptions to a normal assessment.
  25. A complete psychosocial assessment: chart the exceptions to a normal assessment.
  26. A complete musculoskeletal assessment: chart the exceptions to a normal assessment.
  27. A complete musculoskeletal assessment: chart the exceptions to a normal assessment.
  28. Every time they have a bowel movement, I have to chart the color, consistency, and amount.
  29. Every time they’re nauseated or constipated, I have to chart what precipitated it, what I did to intervene, and their response.
  30. A complete genitourinary assessment: chart the exceptions to a normal assessment.
  31. A Braden Scale / Skin Assessment.
  32. A Morse Fall Risk Assessment.
  33. Any and all precautions (fall, bleeding, suicide, swallowing, seizure).
  34. If I updated any family members or if any are at the bedside.
  35. What I’m doing to prevent VTE (if I have an order, what the order is, if it’s in place, if it’s been initiated, if they have screened positive).
  36. Every time I give a medication, I scan it and ensure it’s the right dose, route, patient, med, time.
  37. If it’s a pain medication, I have to chart what pain assessment I’m using, their score and what part of their body is hurting.
  38. I have to chart a follow-up pain assessment with the above-mentioned items within one hour of administration.
  39. For all continuous drips, I chart the appropriate rate and titrate as needed.
  40. I chart and make sure every ML of fluid coming in and going out of their body is accounted for.  This includes oral and intravenous medications and anything the patient has voided, vomited, or defecate.  I ensure the totals at the end of the shift are appropriate.
  41. For every single IV, I chart what it looks like, what the dressing looks like, what is going through each lumen, if it’s clamped or infusing if I changed the dressing when it’s due to be changed. If I discontinue an IV I have to chart it and their response and if I started a new IV I have to chart the size needle, the date, the time, the location, their response, the prep I used, if there was blood return, what the dressing looks like and how I secured it.
  42. If the patient is on multiple IV medications, I have to chart which lumen the medication is infusing into after I ensure it’s compatible with anything else also infusing into the same lumen.
  43. I have to chart hourly rounding, the number of side rails is up, what armbands their wearing.
  44. Every two hours I must chart that they were turned.
  45. Every time they are cleaned and what was cleaned (peri care, oral care, changed the linens, the bed pad, washed their hair, wiped their face.
  46. If they are restrained, I have to chart why they’re restrained, what I did to prevent the need for restraints, what I’m doing to get rid of the restraints, who I educated about it, what I did and what the patient did when I released them every two hours.

Basically, absolutely anything that you do, you have to write down that you did it.  It’s incredibility time-consuming.  So, if you called a patient’s family.. you have to chart it. If you helped them to the bathroom, you have to chart it.  Every time you flush their IV, every time you change the cap on their IV, etc.

Oh, and let’s not forget about patient education and their care plans…

  1. I have to open appropriate care plans and chart on them every shift.  I have to say if they are meeting the outlined goals if they’re progressing or not and type out why.
  2. I have to open appropriate educational topics and chart on them every shift.  I have to chart who I talked to, their readiness to learn, how I educated them, and their response.
  3. This is after I’ve identified the primary learner, their preferred language, their preferred learning style, and if there are any barriers to learning.
  4. I have to check every single order the physician has entered to ensure it’s appropriately ordered and appropriate for the patient.
  5. I have to make sure all quality measure was met and documented appropriately.
  6. I have to check all of their labs, ensure they were completed appropriately and if they’re out of range I have to know and understand why and notify the physician as appropriate
  7. If the patient has a central venous catheter, restraints, or a urinary catheter, I have to chart why.

Keep in mind, this is all we have to chart IF NOTHING CHANGES. If a patient isn’t doing so hot, we have still had to chart the above-mentioned items.  We just have to chart a lot more about what happened, what we did about it, who we notified, when we notified, the MD’s response, and the patient’s response.

If a lab value comes back critically high or low, we have to chart who collected it, when they collected it, the lab test, the value, who we paged, what time we paged, what time they responded, any orders we received.

You can imagine why it’s so difficult for a hospital to implement a new charting system.  And, believe it or not, not only is the nursing staff responsible for charting all of the above on every patient, but many nurses also take classes so that when the physician needs help charting, they know how to help them as well.

So, the next time a physician gets mad at you for all that they have to chart or the computer not working.. please show them this as you help them.

Alright, experienced nurses.. what did I miss?

More Resources for Why Nurses are Always on the Computer:

Nursing Notes the Easy Way: 100+ Common Nursing Documentation and Communication TemplatesNursing Notes the Easy Way: 100+ Common Nursing Documentation and Communication TemplatesNursing Notes the Easy Way: 100+ Common Nursing Documentation and Communication TemplatesChart Smart: The A-to-Z Guide to Better Nursing DocumentationChart Smart: The A-to-Z Guide to Better Nursing DocumentationChart Smart: The A-to-Z Guide to Better Nursing DocumentationCharting: An Incredibly Easy! Pocket Guide (Incredibly Easy! Series®)Charting: An Incredibly Easy! Pocket Guide (Incredibly Easy! Series®)Charting: An Incredibly Easy! Pocket Guide (Incredibly Easy! Series®)DocuNotes: Clinical Pocket Guide to Effective ChartingDocuNotes: Clinical Pocket Guide to Effective ChartingDocuNotes: Clinical Pocket Guide to Effective ChartingRNotes®: Nurse's Clinical Pocket GuideRNotes®: Nurse’s Clinical Pocket GuideRNotes®: Nurse's Clinical Pocket GuideImproving Nursing Documentation and Reducing RiskImproving Nursing Documentation and Reducing RiskImproving Nursing Documentation and Reducing RiskNurse Charting NotebookNurse Charting NotebookNurse Charting Notebook

Nursey Hospital Gift Baskets for Your Loved Ones

Nursey Hospital Gift Baskets for Your Loved Ones

So, your BFF, uncle, cousin, grandma, etc. gets admitted to the hospital and you want to bring something when you visit.  So what do you bring?

I bet anything you would get one of these three things: balloons, some flowers, or an Edible Arrangement.

If your friend/family is in the intensive care unit, typically they cannot enjoy their flowers.  Some hospitals don’t allow balloons.  And a lot of people cannot have the chocolate-covered fruit that comes with an Edible Arrangement.

Well, ladies and gents.. here is my nursey idea to surprise your hospitalized loved one:  a gift basket full of things that’ll make their stay a little easier.  They’ll be so thankful for your thoughtfulness and secretly glad they don’t have to find space for another balloon or flower arrangement.

To get my bag of goodies, I went to CVS.  CVS recently decided to stop selling tobacco products and I try to give them my business as often as possible.  I feel it is my nursey duty to do so.  I highly respect the decision and pray others will follow suit.  You could go to Walgreens, Rite-Aid, Target, etc. to get similar items but I just chose CVS because of their recent awesomeness.

Just to compare, the cheapest Edible Arrangement is $29 for 12 pieces of fruit before delivery/tax.  The cheapest floral arrangement or balloon bouquets at my local grocery store is $29 before delivery/tax.

My hospital goodie bag cost a total of $27.67 after tax

(Note: I did not receive any compensation from anyone for this.. I just want your loved ones to have some great stuff whilst recovering!)

giftbaskets

Alright, let me explain my choices.

  1.  Wide-toothed Comb for $2.99.  No one ever has a a comb.  And the hospital ones just aren’t the same. The don’t stand a chance against tangley hair.  Patients can’t really wash their hair well so it’s inevitably tangley.  This will keep their hair manageable and they can toss it when they’re discharged and not feel bad about it.

Another option: a bottle of detangler.  Many times a family has had to run out to the store to grab some because no one ever thinks they’ll need it until they sit down to try to run a comb through their painfully tangled hair. 

  1.  Burt’s Bees Hydrating Lip Balm for $3.29.  Everyone’s lips are always dry.  Hospital air is dry.  The hospital lip ointment just doesn’t compare to some real legit lip balm.

Note: many times a patient has lost their precious lip balm in their bed and we spend a solid 10 minutes searching for it because they want it so bad. 

  1.  CVS Sensitive Cleansing Wipes for $4.19.  Ok, let’s get a little technical here.  If your loved one is in bed, their ability to get all situated down south isn’t what it usually is.  These wipes are glorious for patients and can make them feel so fresh and so clean-clean in no time.  However, an important thing to do is to get aloe-free wipes.  Aloe harbors bacteria.  This normally isn’t a problem, but if your loved one has a urinary catheter in place, it can mean the difference between getting a UTI and not.  I had to look around a bit for aloe-free wipes, so make sure to look at the ingredient list.  However, if you’re buying this for someone you don’t know that well and it’d be awkward to give them something like this, skip this product and grab something else!
  1.  Suave Advanced Therapy Lotion for $3.59.  Again, hospital lotion is okay but this stuff makes you feel like you’re at home.  Again, get aloe-free stuff.  I had to look at ingredient lists because about half of the lotions contained aloe.
  1.  Just the Basics Facial Towelettes for $2.99.  Rarely can patients walk to the bathroom and wash their face like they do at home.  You feel so normal with a clean face.  This will make it essentially effortless and then they can put some of your Suave lotion on after and feel like a million bucks.
  1.  Travel-Sized Dove Deodorant for $1.27.  It’s nice a small so they can toss it when they get discharged.  After getting washed up, throwing on some real deodorant is the last step to almost feeling normal. Patients LOVE real deodorant from home.  And it smells fantastic.
  1.  Febreze for $4.49.  Hospital rooms are a small, enclosed space with windows that don’t open. Patient bathrooms are much, much smaller.  This means that unless someone sprays something, your room and/or bathroom will smell like poop for a while after you go.  And it may linger out into the hallway.  And you don’t want to smell that and you definitely don’t want your visitors to smell that either.  Febreze is a glorious, glorious gift.

Another option: if you want to tell your nursing staff thanks, Febreze is a wonderful gift for the unit because we have to pay for it out of our own pockets.  And, like deodorant, the hospital deodorizer is nothing compared to bottle of real Febreze.

  1.  Reusable CVS bag for $2.99.  When transferring from room to room, they can throw their stuff in this.  When getting discharged they can use it instead of a patient belongings bag, which is just a thin plastic bag.  When they get home, they can use it for a number of things.  Bonus: when it’s not being used while they’re still in the hospital, it takes up very little space.

More options:

  • Quick and healthy prepackaged snacks
  • Nice shaving stuff. The hospital has some, but the stuff from home is the best.  You can get some nice disposable razors and some high quality shaving cream.  Speaking as someone who has shaved the faces of many who were not able to do this for themselves, the nice brands make a difference!
  • iTunes gift card.  Many people play on their computer or iPad/iPhone to pass the time.  Give them the gift of entertainment!
  • Dry shampoo for those that cannot shower
  • Nice toothpaste and a good toothbrush

Sooo.. what do you guys think?  Do any health care workers have some awesome ideas?  Do any former patients and/or loved ones have any suggestions of what would have made things easier or something someone brought you that made a big difference in your stay?

Insider Info:  What Your Nurse Wants You to Know

Insider Info: What Your Nurse Wants You to Know

Is mom getting admitted to the hospital frequently?   Did your grandma just have a stroke and now your life is half-home and half-hospital?  Many families experience this and they are more than willing to do anything to make it easier for everyone involved – they just need to know what to do! I’ve been a nurse since 2010 with experience in both critical care and med surg nursing. Here is some insider info: what your nurse wants you to know.

Insider Info: What Your Nurse Wants You to Know

Below are some of my top tips for those of you who are finding yourself spending a lot more time in the hospital than you anticipated!

Don’t walk around barefoot on the floor

I’m only mentioning this because, well, it happens a lot. Yes, the floor is cleaned appropriately. But, that doesn’t mean it’s a great idea to walk around without shoes or let your infants crawl around on the floor. Many people are in and out of hospitals, and it’s where all the sick people congregate.

Wash you hands frequently, keep your shoes on, and leave kiddos at home (especially during flu season).

Find out when shift change is and don’t call for updates then  

Typically, shift change is from 7:00 am – 7:30 am. It’s a really hectic time where the off-going nurse is sharing a lot of information in a short amount of time to the on-coming nurse, all while still caring for patients and answering call lights.

Give the on-coming nurse time to meet your loved one and review their chart. If you call at 7:25 am, they probably just learned their name less than 10 minutes ago and need some time to collect their thoughts, meet the patient, and provide you with a quality update.  You can absolutely chat with the off-going nurse, but they’ve been on their feet for 13 hours and are itching to get home and rest. They may have to be back at the bedside in less than 10 hours.

The nurses don’t know when the doctor will be by

Doctors round at random times and we have no idea when that is.  They all have different schedules and routines for when they see their patients. Some have to scheduled surgeries and procedures to work around. The nurses working at the bedside typically can’t see their schedule or know when they’re planning on rounding. Depending on the unit, nurses may have as many as 4-9 patients each, and most patients have a few doctors following them… so, it’s not realistic to expect the nurse to know and have access to the personal schedules of anywhere from 8-18 physicians.

If you miss when the physician rounds, let the nurse know and they can always page the physician and you can speak with them on the phone. I think a lot of people assume physicians are in an office near the patient’s room and can pop back in whenever needed. Many times, physicians see patients all over the hospital and are on-the-go most of the day.

Know what being a full code really means

It is vital to know the difference between a full code and a do not resuscitate (DNR) order.  A full code means that if you heart stops beating and/or you stop breathing, you want the health care team to do everything in their power to get your heart pumping again or breathing again. The health care team will begin CPR, which looks a lot different than it does in the movies and on TV. It’s much more traumatic. Ribs are broken, a breathing tube is put down the throat, the patient is heavily medicated.

While most people will say yes, do everything you can if that were to happen, not everyone wants that. Some people are living with a terminal illness, some are of advanced age, or have a diagnosis like dementia.

Upon admission to the hospital, the physician who is admitting you should have this conversation with you to ask you if you want to be a “full code” or if you’d like a “do not resuscitate” (or DNR) order. This is done at admission with everyone because if that situation arises in which the patient begins to “code” (heart stops or stops breathing), we can’t have this conversation then.

A DNR communicates to the health care team whether or not to begin CPR *if* the patient begins to code. A DNR does not mean the patient will receive less medical care, fewer treatments or interventions, it simply means that *if* the patient’s heart stops or they stop breathing, that we are to let the patient pass naturally rather than put them through the trauma of CPR.

If you have more questions about this or aren’t sure what the answer is for you, talk about it with the physician who knows you best: your primary care physician.

Make sure next of kin or health care of power of attorney knows your wishes

I cannot tell you how many times a terrible, yet necessary, decision must be made and the next of kin can’t decide to let their loved one pass or not, or they haven’t  spoken to them in years so they don’t now what they’d want… or there’s no health care power of attorney.

If all of a sudden you were unable to make your own decisions are incapacitated, who would make decisions for you? In most states, it would be your next of kin (spouse, family, children – it all depends on your unique circumstance). But, not everyone wants their next of kin to be this decision maker. An example would be a married couple who is separated but not legally divorce; they may not want one another to make those decisions but should a tragic accident occur or sudden medical condition, legally it would fall to that person because they are still their spouse.

There is something called a health care power of attorney. This is a person you designate when you are of sound mind that will make medical decisions for you. There are some legal documents you fill out and then you give a copy to your physician and the hospital.

This person can ONLY make medical decisions on your behalf if you are unable to do so. They can’t call the hospital and make decisions on your behalf if you are of sound mind.

Whenever you select this person, make sure they know what you would want at end of life. If you were in a car accident today and the choice was either live in a nursing home for the rest of your days on a breathing tube with a feeding tube, or death – what would you want?

Select someone who knows your wishes, respects them, and will make the right call for you.

Put on your call light and ask to go to the bathroom before it’s an emergency, if you’re able

Emergencies happen, people forget, or there is a crisis, and we can’t get to your room immediately to take you to the bathroom.   Sometimes it takes 20 minutes.  Please let us know when you have to go and early!

However, we know not everyone get adequate warning of when they have to go to the bathroom. Sometimes when the urge hits, people need to move! If this is you, just let your nurse and nursing assistant know. That’ll let us know that when you put on your call light, we need to high-tail it in there. I’ve had many patients with irritable bowel syndrome or urinary urgency and frequency and they just let me know when I meet them in the morning and I just consider that throughout the day as I see call lights go off and I prioritize my tasks.

If you feel like you don’t see your nurse much, you may be their most stable patient

Emergencies and urgent situations happen a lot, and nurses can’t tell their patients about what’s going on with their other patients. Chances are, if you haven’t seen your nurse much, he or she may be tied up with another patient who is not doing well.

Ask questions!

If you don’t know why you’re getting a certain medication, test, procedure, ask!  And when you think of questions, write them down so you don’t forget!  I love love love it when a family member has a list of questions ready for when the doctor rounds. The nurses do their best to answer your questions, but typically there are questions we can’t answer and the doctor needs to address that with you.

Also, try to write your questions down as you think of them and answers as you receive them. This makes it easier to put the pieces together. Most patients have a lot going on and it can be tough to understand. Keeping notes of what happens or changes can help you get your mind around things.

I’m such a big advocate for this that I wrote a book for patients and loved ones to understand the interworkings of hospitals and including some blank pages with leading questions in the back!

I’ll always say your test results aren’t back, even if they are

It’s not within my scope of practice to interpret or tell you what they are, even if I know.  If you just found out you had cancer or an aneurysm or a stroke, you would probably have many questions and your physician needs to answer them.

It’s hard to be on the receiving end of the test, knowing the nurse knows but won’t tell you – which is why many of us simply say the results are not back yet, even if they are.

If you loved me, it’s definitely okay to bring me food

I’ve had multiple patients try to sneak me a monetary tip or a gift card. Alas, legally, we can only accept perishable gifts.

Many families have bought pizza for the staff, or a coffee tote from a nearby Starbucks or Panera. Most nurses love coffee and tea but can’t get away from the unit long enough to grab some, so a 1-3 totes (depending on the size of the unit) is a wonderful surprise. We are typically bombarded with sweet treats, so healthy snacks are a great gift too. Things like protein bars, granola bars, fruit, veggies, hummus, nuts, sparking water, are all great ideas to show your appreciation for your nursing staff.

More from the author

About the author

Kati Kleber, BSN RN CCRN-K has been a registered nurse since 2010 and has experience in both cardiac med-surg and neurocritical care. Kati is a podcast hostnational speaker on nursing topics, and trusted source for various media outlets like US News and World Report, Dr. Oz, CNN, the TODAY show, and more.

She was named Nurse of the Year by the Charlotte Business Journal and was a Great 100 Nurses of North Carolina Recipient, both in 2015.

Kati is a published author of five titles, including Admit One: What You Must Know When Going to the Hospital, But No One Actually Tells You, the first book published by the American Nurses Association specifically for patients.

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