The Secrets Nurses Keep: 1/2

In the November, 2011 issue of Reader's Digest-- there was an article entitled 50 Secrets Nurses Won't Tell You. I mean, of course, I am going to read this. As a nurse, as an author, and as a blog editor-- I'm going to see what it has to say. Please, take some time to check out the full article.

I thought I'd give my thoughts here on whether or not I agree with the trueness of these statements. I'm not sure that's truly a word-- so don't use it in Scrabble or anything. The items are taken directly from the article-- so credit is given to Reader's Digest for these.

Item One: "When you tell me how much you drink or smoke or how often you do drugs, I automatically double or triple it." A longtime nurse in Texas.

Jordyn Says: Absolutely TRUE. A person over the legal limit has surprisingly only EVER had 1-2 beers. Always. What I will add to this statement is a teen driver who comes in involved in a minor traffic accident. I always add at least 20mph over the limit they state because they are likely not going to be truthful in front of a parent about how fast they were really going.

Item Two: "We're not going to tell you your doctor is incompetent, but if I say, 'You have the right to a second opinion,' that can be code for 'I don't like your doctor' or 'I don't trust your doctor.'" Linda Bell, RN.

Jordyn Says: This is a tough one for sure. What is the nurse to do? Primarily, we are an advocate for the patient and NOT the doctor. I have been in this situation. Not necessarily with a diagnosis but more with the emergency treatment provided for the patient. I had a sick asthmatic once at a hospital where I worked previously and the doctor was ready to discharge the patient after one treatment when really the patient needed a barrage of treatments and steroids to control the asthma attack. The child was still in obvious respiratory distress. I had the doctor reassess. They didn't agree with my assessment (and clearly-- I'm always right.) At discharge, I told the family, "Look for these respiratory signs that your child should be seen in the ER." The mother says--"Well, she has all those right now." My response, "Exactly." Wink, wink. "I know this ER is open."

A nurse puts herself and the hospital in a bad position and will never outright say a physician has made a poor decision or is incompetent but be mindful of language and if a nurse says-- "do such and such" like get a second opinion or seek out this course of action-- do it.

A nurse can also approach another physician on duty to see if they'll assess the patient and/or they can call a medical director for intervention. I've done this as well when I thought the treatment/or lack of-- would result in a patient's death.

Item Three: "If you're happily texting and laughing with your friends until the second you spot me walking into your room, I'm not going to believe that your pain is a ten out of ten." A nurse in New York City.

Jordyn Says: True. True. True. Amen, brethren in New York!

From the time a nurse goes through nursing school, we're taught that pain is subjective and the only person who can truly assess how significant pain is is the patient themselves. In many situations, the patient overestimates their pain.

The general scale used is 0-10. Zero being no pain and 10 being the worst. I've started to say, even to pediatric patients, "a 10 is like someone took an ax and chopped of your arm." A 10 means you cannot sit still in a chair. A 10 means if I don't do something about the pain, you'd rather die than live with it any longer. You cannot text. You're not laughing and joking. Do we still treat the pain-- yes, but a nurse will report to the physician your demeanor and that does influence the amount of the narcotic you'll get.

A nurse will also advocate for a patient who should get more pain medication or in instances where the patient or family refuses pain meds. I had a girl with an obviously broken arm and her father refused to let her have Ibuprofen. I'm guessing he had a religious objection but wouldn't say it out loud. Normally, I'm all for a parent's right to have a say in their child's treatment but this time I'm practically begging to give this child Ibuprofen. He says--"shouldn't I be able to decide her treatment"-- oh, that's a whole other post for sure. I said, "Well, perhaps if it was your arm that was broken, you might think differently." One of the few times I actually said what I really wanted to say.

What do you think of these situations?