mercenary nursing

I think I know why nurses never seem to do as well as the others. By 'others' I mean school teachers, firemen, and policemen.

Reason 1. It's a female dominated profession and women have traditionally been screwed over by men ever since time began. Even in today's modern western world, women genererally are paid less than men.

Reason 2. People who become nurses are generally very caring people. I've known quite a number of nurses who said they would never push for a pay rise because that would mean the hospital would go broke and the community would suffer if it was forced to close.

Simply put, nurses will never earn as much as their other public service coleagues.

So what am I going to do about it?

Well, I'm trying not work in a hospital. This is a shame as it's one of the most rewarding types of nursing, you know, directly helping those most in need. But other jobs outside the hospital, in the private sector, pay better. It's a shame, because working for the rich is really quite degrading at times. They don't ask, they demand. They don't say 'Thank-you' because they are paying you for a service and don't see why they should say Thank-you for something they've paid for.

I could say more, but I'm sounding too bitter. I do care, but maybe I care more for the poor and needy. Is that so wrong?

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Going against the parents

At six pm my cell phone rang. I put down my dinner plate and answered my cell phone. "Can you come quickly, he's breathing funny" said the woman on the other end of the phone. "Hello, who is this?" I asked. "Is this the nurse on call?" asked the stranger on the end of the line. "Yes. Now calm down" I spoke calmly in the hope of getting the women on the other end of the line to follow my example. "Now, who are you, and who is having breathing problmes, and where are you?" I asked.

The caller was Mrs Anderson, a teacher on duty in the junior boys' dorm. She was with a boy called Mohammed who was breathing rapidly. The boy had no history of asthma, no medical problems, and according to Mrs Anderson, no sign of any injury. I told her I'd be there in five minutes.

My diagnosis was instant, although I still gave him a full check up. Mohammed was sitting outside on the steps because he said the 'Air was more fresh.' He was breating at a rate of 40-45 breaths per minute. At 85 beats per minute his pulse was fine, and his blood pressure was a healthy 125/75. His hands were beginning to cramp, looking like a bird's claws.

I sat down next to Mohammed. I moved slowly and calmly, every movement, every phrase aimed at creating a calm environment, my body language trying to say 'Don't worry, you'll be ok.'

Mohammed was having what is known as a 'Panic Attack'. With end of year exams about to begin he'd been getting more and more worried the closer exams came. As far as 'Panic Attacks' go this was definitely a good exmple of how nasty they can be.

I spent the next hour talking to him, trying to get him to slow his breathing, trying to have him blow into a paper bag, but it was all to no avail. I called the emergency doctor but he was busy with an emergency and couldn't come to see Mohammed, but he gave permission for me to give Mohammed a medicine to calm him down.

The medicine worked wonders and withing twenty minutes of taking the small tablet he was fast asleep in bed.

"I want the doctor to see him now" insisted Mohammed's dad. I had to hold the phone away from my head as he was nearly shouting down the line. "I'm sorry, but the doctor can't see him, and besides, Mohammed is fine now, he's fast asleep" I said. I had spent the last twenty minutes explaining very simply what had happened, but it wasn't getting through. "You're just a nurse, I want a doctor to physically see him and assess him. Take him to hospital, call an ambulance. I don't care, but do your job. He's my son and you will do as I say."

Nurses are generally understanding people and put up with a lot of abuse, but not when it comes to compromising their patients. "I'm sorry sir, but that would be the worst thing to do to Mohammed right now. It's taken a lone time to calm him down, and finally he is asleep, his breathing is fine. It really would be wrong to wake him, especially to drag him out of bed and take an half hour drive down the mountain. It could trigger another panic attack." I was determined not to wake Mohammed up at this stage, it would be the wrong thing to do, and may even make him worse. I had to stick to what I knew was right, regardless of what the parent said.

"You're telling me what I can and cannot do with my own son. I want a doctor, no, a I want a specialist to see him tonight or you won't have a job by the time I'm finished with you" screamed Mohammed's father. "I'm sorry you feel that way, but I'm doing what I know is right for your son. You left him in our care, you trusted us to make the right decision. That's the issue sir, you're not here to assess your son. I am. If it makes you feel any better I'll be checking on him during the night and will take him to the doctor in the morning. I'll call you then. Goodbye" I turned off the phone.

Mohammed woke the next morning back to his normal self. He was at breakfast with his friends, laughing, running, doing all the things a healthy teenager should. I had made the right decision, alhtough I did wonder if it could have been handled better.

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Moral vs Professional Nursing

Again, we have people complaining that if I can’t do something, a specific nursing task because of my beliefs, then don’t be a nurse. That sounds a little intolerant? The nurse who said this obviously hasn’t thought about all the good things that people can do, without going against their values/beliefs.

Nurses are supposed to be tolerant and caring, but so often we and intolerant to each other. Another important thing is compromise and working things out together. If you have a good team of nurses working together, then it is together that you can work with or around people’s weakness/strengths.

Why does everyone leap down my throat when I even mention about nurses not doing ’something’ I’m not talking about picking and choosing patients, I’m not talking about refusing vital care, I’m just getting people to think a bit about their own values and beliefs and how it blends in with their care, ie Does it affect you.

If you say it doesn’t then you either can’t see it, or you’re lying. It’s our beliefs/values that make us who and what we are, they influence us in every decision we make. Even if it means making the conscious decision to go against our beliefs/values to do what is needed for a patient. By making this decision, we are automatically incorporating our beliefs.

Everything is compromise. It would be nice if those people so willing to suggest I should end my nursing career, just because I dare mention that my own values/beliefs could influence my care, could be a little more caring towards another nurse as well as look at ways of compromising with their colleagues.

The question that needs to be asked is: “Where does professional responsibility end and Moral obligation begin?” For example, a doctor may believe in Euthanasia, while you don’t. The doctor asks you to administer a bolus of morphine. Or perhaps instead of administering morphine, they just withdraw care. What is your obligation? What helps you decide how to react and choose what to do?

What if you were working in a country as an aid worker and female circumcision is commonly practiced? What would you do? What if the patient is accepting of this, even wants this as in her culture this is expected? I’m pretty sure you would be in a moral and professional dilemma.

Overall I am disappointed at the reaction of my fellow nurses, to questions which are supposed to make you think.

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Knowing too much

Sometimes I feel the phrase 'I know that I know nothing' just about sums up my nursing knowledge.Does anyone else feel this way? It seems that the more I learn, the more I realize how little I know. This is a good thing really, as over confident nurses can be dangerous. An example of an overconfident nurse happened last year, although I will add that we were in a difficult situation and I'm still undecided if what we did was right or wrong. I'm curious to hear what you think.

I'm currently working in a private boarding school in Europe, high up in the mountains. I work with two other nurses, one of whom was a very experienced emergency room nurse from the USA. Every time I had a question, she always knew the answer. She also kept herself up to date with the latest advances in medical procedures. Unlike me, she could name all the bones, muscles, and ligaments in the body. I felt rather inferior, even though I've had twelve years of work experience.

Anyway, it was a sunday night and one of the children (17yrs old) managed to dislocate his shoulder falling out of his bunk bed. By the time I managed to see him, 15 minutes after receiving the call, it was eleven o'clock at night. His left shoulder was definitely not where it should be, so with the help of a few of his dorm mates we hobbled along to the infirmary, which happens to be in the same building where the kids sleeps.

We lay him down on the examination table, the pain severe. He was pale, sweaty, understandably very vaso-vagalish. Unfortunately, our regular village doctor who we got on very well with, was away on holiday, and so we were left with a locum doctor.

Unfortunately we had had some run ins with the locum, especially as he had refused to come and see a patient of mine earlier on in the week, which resulted in me taking a one hour drive in the middle of the night down the mountain to the nearest hospital. The poor girl had the worst migraines I had ever seen. Nothing worked for her, and she is the only migraine patient that I have seen morphine used. She was in the back seat, supported by two of her friends as she vomited nonstop the entire trip. It was a harrowing experience for all, but we had no other option.

Back to my patient with the dislocated shoulder.

So before calling the doctor I called my colleague for advice as well as moral support. "It's defintely dislocated" she said to me after examining our patient. "Well, I'd better call the doctor" I said. She looked at me and smiled, "I can fix this. I've seen it done many times in the ER, it's easy." I began to protest "I'll call the doc first anyway, he'd better know what's going on." My colleague agreed, although I could see she wanted to have a go at the shoulder.

The doctor didn't answer his phone. I tried three times and no reply. The hospital was an hour away, it was night time and our patient was in agony. I watched as she put his shoulder back in place.

The relief was instantaneous. The lad was praising my colleague, as were his friends who watched the procedure. We placed him in brace and gave him some Ibuprofen, and sent him to bed. "Told ya it was easy, nothing to worry about" my colleague was in high spirits. "If we get another one, I'll let you have a go." I shook my head, "We're not supposed to do that" I mumbled, unable to look her in the eye. "I guess it's a bit out of our scope of practice, but did you really want have him suffer in the back of the car all the way down the valley?" She had a point and I kept quiet.

To this day the incident still upsets me. What if he had a fracture as well as a dislocation? What if some vasular damage had been done. The boy was x-rayed the next morning and everything was ok. But I guess what worries me the most the way in which she was so sure of her diagnosis, was so sure there was no fracture. She was skilled and knowledgeable, too confident, but lucky...this time.

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