24 Nursing Lessons I Learned @DAFH

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After 24 months of serious hard work and infinite memories, my time in Dar Al Fouad Hospital is drawing to a close. I have to admit that during the entire time, I learned a number of things about my awesome profession and my dead personality. Some are too good to be true that I can't seem to forget them, while others are just as lame as my dark life. Trust me on that last statement. Seriously.

In lieu with this upcoming closure, I have decided to publish a few "24" stuff that are too dear to me. I have this weird yet sweet feeling that this will be a neat one. Hahaha. :-D

24 Nursing Lessons I Learned @DAFH

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1. Always check a patient's Vital Signs.

This is the 1st thing a nurse should learn. Refer anything that is unusual considering a patient's history and medication regimen. He may have been hypotensive all along or taking anti-hypertensives for 10 years without your knowledge.

2. Check everything and recheck with someone else.

One can never be sure about everything. It is good to know that someone's there to countercheck everything that you're doing. We can't run around the unit singing Human League's classic hit "Human, Born to make mistakes." It sounds so overrated. Duh!

3. Respect your co-workers.

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Respect begets respect. My mother taught me that way back in grade school. Keep in mind that no matter what happens, your co-workers are human beings with the same amount of rights as you are. Black or white, Asians or Caucasians, we're all the same.

4. "Smile though your heart is aching."

Amidst all the hardships that this noble profession entails, a nurse should show genuine compassion to his/her patients. Leave all your hardships and problems at home or face eternal damnation from your co-workers, patients and, most probably, your supervisor.

5. Never forget the basics.

1+1=2, right? The same thing applies to work. One can't easily advance to the next higher task or skill without perfect mastery of the fundamentals. You'll have to learn every detail and practice as much as you can if you want to be on top (ANTM?). Bed making, anyone?

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6. Admit your mistakes and learn from them.

In direct relation to #2, sooner or later, you will commit an error. And that specific error jeopardizes not only your job or salary, but most importantly, your patient's life. Protect yourself with an incident report signed and witnessed by a co-worker and your immediate supervisor. Do be specific about it and maintain confidentiality. Look who's talking about secrets, oh? :-)

7. Never give a Marevan tablet without an INR result.

Marevan (Warfarin) is an oral anti-coagulant used to stop blood clots from forming within blood vessels. INR, International Normalised Ratio, measures the effectiveness of the aforementioned therapy. Usually, doctors would order this lab exam OD to monitor a patient's clotting ability. Then, depending on the patient's response, they adjust doses and replaces the former order to EOD. Refer these INR results before Marevan administration to ensure patient safety and avoid unwanted complications.

8. A patient is more important than a file.

Time and time again, I have always stated the obvious: attend to the patients' first before their files. Your patient might be dying at that instant while you're too busy writing insignificant events that can be written at a better time. Do not forget significant events or findings, though.

9. Ask if you're not sure about a certain procedure.

If you're clueless about a peculiar procedure, ask your seniors. Most likely, they know what to do, when to do it, who to do it with, where it would be done, and how to do it correctly. Don't pretend you know everything or its off with your head! *evil laugh*

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10. Be a team-player.

Master the art of working WITH your co-workers. Help them whenever you have the chance without asking for anything in return. They might do bigger and better things for you in the future when deemed necessary. Lionel Messi wouldn't be THAT GREAT without his teammates, right?

11. We work for our patients. Not their relatives. Not even doctors.

Nurses are professionals. We are not slaves, maids, waiters, house-keepers, bodyguards, doctors, wizards, pharmacists, children, porters, animals, secretaries, court jesters, students, etc. Do us a favor and erase those nasty things from your narrow heads and learn to appreciate our humbling and honorable profession. Thank you. :-D

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12. Befriend doctors for you'll surely ask them certain favors in the future.

Honestly, doctors can get pretty annoying at times. Writing orders are way too easy compared to bathing a bedridden orthopedic patient. Yet, they're still there, alive and kicking, writing and ordering. Learn to appreciate their very existence and be kind to them in spite and despite of everything. Do small things for them to build trust and surely, they'll do the same thing for you. Trust me. I KNOW.

13. Never mix Cordarone with Normal Saline. Use Dextrose 5% solution.

I learned this one from my recent Code Blue experience about a month ago. Cordarone is an antiarrythmic drug used to treat ventricular fibrillation and unstable ventricular tachycardia. When preparing such medication, dilute an ampoule ONLY with Dextrose 5% solution or you'll get a cloudy, useless mixture (when diluted with Normal Saline). Additionally, a cardiac monitor should be at hand to assess and reassess the effectivity of the said infusion. Thank you, John Boy and Mark for the additional information!

14. Whenever a patient complains, assess.

The nursing process starts with the word ASSESSMENT. Nurses should use this reliable tool to identify problems that can and will hinder a patient's recovery. When a patient complains of pain, ask where the pain is and how painful it is via a 1 to 10 scale. If he/she is complaining about the remote control, see if it has a battery or if its functional. You never can tell, eh?

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15. Your supervisor should be your bestfriend.

This may sound bad but, on the contrary, it isn't. Supervisors exist in order to supervise every single detail within the unit. Oftentimes, we get mad at them for pushing us to our limits or bullying us around like preschoolers in a daycare center. However, they will always be there watching your back in emergency situations. Plus, they'll defend you against virtually anything that this world has in store. Thank you, Ms. Mona!!

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16. Touch is therapy.

Take this distinct one both literally and figuratively. Literally, meaning, holding a patient's hand when he/she is alone or afraid of an impending outcome. Yes, they'll hold your hand too tight most of the time but it really, really helps. Figuratively in the sense that you are there with and for them, all the time. Time consuming, right? Your presence is more than enough to alleviate their escalating anxiety. Be there for your patients. It means a lot to them, seriously.

17. Rules/Policies exist to protect us. Not to spite us.

The upper echelon of the hospital where you are currently working created these ironclad words in order to safeguard everyone connected to them: patients, doctors, nurses, office clerks, etc. Yes, these statements irritate and, most of the time, limit the way we want to work to the point wherein we become so frustrated about the entire infirmary. Remember: This is a hospital and not a playground. We deal with lives. Not toys.

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18. Venipuncture is a skill that needs time and practice.

Inserting a peripheral cannula is not an easy task. There are a number of factors to consider before venturing off to install one: Anatomy and Physiology, diagnosis, nurse-patient rapport, expertise, etc. Any nurse can perfectly ace an exam about Intraveous therapy yet fail to insert one when the need arises. It takes both theory and practice to become an archer of cannulation. I badly need some practice, for crying out loud.

19. Patients have the right to refuse their treatment regimen.

Patients have the divine right to refuse any procedure or treatment that is available for them. This is in line with their sense of autonomy, wherein they are given the option to decide on the course of their treatment. Be sure to inform their primary physician as soon as possible, clearly explain the consequences of their actions, and immediately document these events as a precautionary measure.

20. Use your eyes and not your mouth.

When looking for something, files in particular, search everywhere using your two eyes and not your stinking mouth. Do everyone a favor, Dr. H-Feet, rummage around the unit before asking or complaining. Besides, I'm not your assistant.

21. Most diuretics should be given in the morning.

Diuretics are medications that increase the rate of urination, thereby producing the term "forced diuresis" (Wikipedia, 2010). Always consider giving these medications in the morning, unless specifically ordered by the physician, in order to foster sleep at bedtime. You don't want you're patients complaining of sleep deprivation the following day, right?

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22. The weight of the narcotic cabinet key is directly proportional to its responsibility.

This has got to be my personal favorite! Promise! The narcotic key is one of the most important things a nurse should understand. It's as significant as your watch (maybe even more!) and loosing it can be a huge problem. I misplaced it a few months back and we had to turn the complete unit upside down in order to find the damned key! Yikes! Ms. Nenita was furious as hell! Luckily, I found the freaking key inside the storeroom within a urinal. Hahaha. Do be careful with it or you'll surely face the nearest jailhouse.

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23. Time management is the key to a healthy shift.

Control and organize the things that you need and want to do beforehand. At times, things could get pretty unorganized and unpredictable inside the wards and you often find yourself stressed with too much workload. Prioritize tasks at hand and discern them accordingly.

24. Work like an Orc but party like an animal.

After each shift, leave your work behind and let loose. Eat as much as you can and live a life outside the hospital. There's got to be more to life than medications and patient complaints, right? Celebrate and be merry that you have successfully finished your shift to fight another one tomorrow. Or the day after that.

Do click here for more nursing lessons from my previous entry.

Coffee, anyone?