Earlier this May, nurses around the country were acknowledged on a countrywide scale for their hard work and dedication to patient care during National Nurses Week (May 6 - May 12). Unfortunately, as with most national appreciation days that I cannot personally be recognized for, I failed to take much notice.
Now that new doctors around the country, including myself, are in the process of growing into our roles as team-based health care providers (see earlier article for more on this), we are in the unique position of working extremely closely with nurses on the hospital floors.
From this first-hand observation, I found it amazing what these individuals can accomplish. Below is my attempt of characterizing only a few of the many hats that nurses wear on a typical day in the hospital.
Caretaker
As a physician, part of the daily grind involves visiting each patient on my service a few times a day to conduct physical examinations and discuss treatment goals. Much of the rest of the workday takes place away from the patient room: coordinating care, writing orders, and developing short and long-term treatment plans. In an admittedly self-absorbed fashion, I rarely take the time to acknowledge how much patient care is accomplished without my presence at the bedside. And much of this care can be directly attributed to the nursing staff.
Take the ostensibly-effortless activity of dispensing medical regimens as a case in point.
Many hospitalized patients require more than a dozen different daily medications that are to be administrated at various hours and in multiple ways (I'll leave these different routes to your imagination). Although physicians have the responsibility to put in orders and ensure that their patients receive the appropriate daily medication throughout their hospital stay, it is the nurses that actively dispense the medication, often to multiple patients throughout the day.
It makes me winded just thinking about it.
As if this wasn't enough to push nurses into continual overtime, it amazes me how much nursing care is required to keep patients from experiencing hospital-acquired adverse events.
There are dangers in having patients remain in bed for extended periods of time (veins clot, pressure ulcers form, muscles weaken) and someone needs to prevent them from occurring. Although certain preventive medications help reduce these conditions, it is the nurses on duty who routinely check patients for any signs of such de-conditioning.
Adding these instances to the plethora of other nursing care responsibilities (ensuring adequate nutrition and hygiene, preparing patient for admission and discharge, etc.), it is remarkable to think that patient care encompasses only one facet of a career in nursing.
Educator
Any person can become a patient, but only those who have been previously hospitalized know what to expect when being admitted to a medical center. As mentioned in previous articles, a few-day stretch in a hospital room is no five star hotel stay. There is a unique schedule of events surrounding a hospitalized patient's care that is entirely different from an otherwise normal day outside of the medical floors. Consequently, someone is required to educate the patient on what to expect while in the hospital. And that someone is often the nurse on duty.
As much time and effort that may take, especially in the setting of multiple patients, a nurse's role as an educator does not stop there.
Consider myself along with the cluster of 10,000-plus newly-hatched doctors swarming medical centers across the country this summer. Who plays the major role as the bedside teacher of patient safety, the invaluable sage of the local electronic medical record system and the go-to personage for tips regarding the behavioral quirks of patients on the medicine floors?
You guessed it.
A quick side note to medical students and fresh interns: The more respectful and friendly you are to the nurses on your medical team, the easier your professional life will become. Fact.
Health Care Provider
There is no question that nurses have their hands full with the many implied responsibilities they take on when signing up for this career in health care. It is of my opinion that out of all of these functions, the most trying duty of a nurse is assuming the role of a front-line health care provider.
Let me break this down for you with a brief case.
A 65-year-old man with a history of high cholesterol, high blood pressure, and with recent episodes of intermittent chest pain is admitted to the hospital. On the morning of his second day of admission, the patient begins to feel chest pressure, pain in his left arm, sweatiness, and nausea. He calls out for help.
Who do you think is first at the bedside?
One might assume it is the patient's doctor who whimsically appears out of thin air to start up the necessary diagnostics and treatment for this concerning clinical presentation. Indeed, it is the patient's nurse who has the immediate responsibility of identifying the classic signs of this patient's heart attack and initiating life-saving medical care.
(Of note, I've based the above scenario on a real patient's experience, and I have no doubt that the nurse on duty that day saved his life.)
Take Home Point
Throughout history, the culture of medicine has revered the role of a physician as the core to patient care and medical recovery. Yet in my personal work experience, absolutely no care would be delivered without the critical role of a nurse.
So whether you are a doctor or a patient, a friend or casual acquaintance, the next time you run into nurses that you know who are just getting off of a 12-hour shift, buy them a drink. More likely than not, their workday was unrelenting and they are apt to need one.
And who knows, you might need them someday.
For more by Brian Secemsky, M.D., click here.
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