Nurse Anne's Information Pamphlet for Patients and Relatives: PART 1

I would like to print out a little pamphlet called "let go of your delusions" and hand it to every alert and oriented patient who arrives on my floor.  And all relatives.  This does not, of course, apply to confused patients, demented little old ladies or drug addicts going through acute withdrawal. I expect those patients to act like circus animals. However, if you are an adult who has voluntarily sought help for a medical problem, and are now lucky enough to even be in a hospital bed, there are some things you should know.  Thanks to the posters at allnurses from whom I stole  borrowed this idea. Writer's block is a bitch.


#1. YOU WILL NOT SLEEP. This may sound cruel, I mean, how can you get better if you don’t sleep? However, if you come to a hospital expecting a nice, quiet spa environment with cute nurses fluffing your pillows before you drift away into a healthful sleep, you are delusional. Time is short – the government and managers want as many people in and out of your hospital bed in as short a time as possible.. You will be woken up throughout the night to have blood drawn, blood pressure taken, IV meds administered, quick neuro assessments to ensure that your brain is not oozing blood. You will also likely hear people screaming and crying, cursing and laughing all night long. If you are lucky, it is not your own confused roommate who is constantly climbing out of bed only to set off his bed alarm.  We cannot cure dementia or give them a magic pill.  They may very well walk into your room and shit in the corner.  They may try and get into bed with you.  They will scream out for "billy" or "help" or another dead loved one all night long no matter what we say or do for them.  They will not remember or retain anything we tell them.  This is dementia. These kinds of patients are increasing tenfold.  Unless you are in maternity or paedatric wards we cannot shelter you from this.  It's not only dementia.  Patients with severe medical illness, and other conditions will become confused, disorientated and unmanageable, even without the dementia factor.  This is also increasing ten fold as more people survive severe illnesses. The hospitals are busting at the seams with these people.  I even heard of a demented wandering elderly patient getting put on a maternity ward as there was no other place for her.  We are lacking beds.  No we cannot "send them somehwere else" or just "give them something".  Wish I could.  If you think you may need something to help YOU sleep, 3:00 AM is NOT the time to ask your nurse for temazepam. Ask ahead of time when your registered nurse can call the doctor for an order. Which brings me to my next topic. . .



#2. YOUR NURSE DOES NOT HAVE ACCESS TO ANY DRUG THAT MEETS YOUR FANCY. If you suddenly feel pain or your left knee itches, your nurse cannot reach into her magic scrubs pockets and procure any drug you like.  Nor can she just get and give anything your normally have at home as prescribed by your GP.   In hospital Doctors are the one who must order any and all medications, EVEN IF IT’S “just my usual piriton". Do not get mad at the mean nurse who won’t bring you extra morphine because your back hurts. That mean nurse must put out a call to a doctor, has wait for him/her to call back, pray that he/she is in a good mood and will give you the requested drug, write an order in the chart, scan that order to the pharmacy, wait a zillion years for the pharmacist to profile the medication, wait another zillion years for the pharmacy tech to bring the medication, then the nurse can bring you your drug. This can take a while. There is absolutely no way around this, even if you have a gun to my head. Do not think the nurse is secretly hiding your medication and enjoying your  discomfort. Which leads nicely into my next heading. . .



#3. THE NURSE IS NOT YOUR ENEMY. Yes, the nurse must do things that sometimes causes discomfort – we must start IV lines, insert catheters, change dressings on painful wounds, give you shots – but we do these things to help you get better. We take no joy in them. You know that doctor that just left your room? The one to whom you were very nice and polite? The one to whom you listened quietly, asked no questions, and didn’t bother to tell that you are bleeding profusely out of your rectum or experiencing chest pains? Yeah, well HE is the one who orders these tests and blood draws and procedures. Speaking of that. . .



#4. TELL YOUR DOCTOR ABOUT YOUR SYMPTOMS. I cannot believe how many patients lie there quietly, smiling away when the doctor is in the room asking how they are feeling. “Oh, fine, Dr. Bighead! I feel great!” then. . .5 minutes later when the doctor has left the floor, this same patient is suddenly in excruciating pain, has numbness in her right foot and blurry vision. When asked why the HELL they didn’t tell the doctor who just left, they shrug “oh, I don’t know. . .I didn’t want to bother him. . .he is so busy.” Then the nurse must call the doctor and tell him that the nice, smiling patient they just saw is now a quivering mass of pain and can’t feel her own face. This leads doctors to think that nurses are nutcases. And it leads them to scream at us for paging them 5 minutes after they walked off the ward on their way to see their other patients, a job that takes them all day even if they rush and take short cuts. But mostly they just think that the Nurses are exaggerating or crazy. Which takes me to my next point. . .

#5. DO NOT TAKE YOUR ANGER, FRUSTRATION, ANNOYANCE OR SCHIZOPHRENIC HALLUCINATIONS OUT ON YOUR NURSE. In general, doctors are treated like gods and nurses are treated like shit. Plain and simple. We as nurses try to proclaim that we are professionals and that we make a difference – in actuality we are treated very poorly by most people in the health care world. We are in the very difficult position of being the “coordinator of care” for patients, yet we lack any power to actually make decisions. We have all the responsibility but none of the power. I spend so much of my day making phone calls, trying to make things happen. Trying to get test results, find out what is going on, talk to the doctor, get medications ordered, figure out why the patient has not yet had that MRI of the brain or echocardiogram. Nurses are viewed as nagging wives. . .and tend to be treated as such. But no one else in the hospital is going to take responsibility for getting this stuff done for you. Doctors, in general, do not talk to nurses, they do not tell us what is going on with patients nor do they tell us the future plan of care. For me to figure out what is going on, I often have to try to read the doctor’s handwritten progress notes, which is pretty much like trying to decipher ancient Egyptian hieroglyphics on a pyramid wall.  I cannot sit at the nurses station for as long as it takes to read their notes. There is very little direct communication between doctors and nurses. If you want to know if you have cancer, for the love of god, ASK YOUR DOCTOR.


#6. YOUR NURSE HAS 10-20 OTHER PATIENTS, SOME OF WHOM ARE A HELL OF A LOT SICKER THAN YOU EVEN IF YOU ARE PRETTY DAMN SICK.   Nurse has no control over how many patients she has but she maybe looking at a manslaughter charge if she goes to clean the incontinant lady before she gets to the diabetic with the hypostop. If you ask your nurse for some coffee and a newspaper, and she tells you that it will be a few minutes, do not get huffy and demand to see her nursing supervisor. For all you know, that nurse has a patient in the next room who is not breathing or is in desperate need of some pain medication. As nurses, we must prioritize, and yes, my “least sick” patient will get less of my time. This is not to say you are not important and I am ignoring you, but no, I don’t have time to listen to you whine about your chronic neck pain when I have another patient who is having a seizure or gasping for air as he drowns in his own secretions. I get no help with this.  I just have to prioritize all the time.



#7. “H” DOES NOT STAND FOR “HILTON. Don’t complain to me about the food, the lack of TV channels, the view from your window, the “smell” of the hospital, of not being able to take a shower or go downstairs for a cigarette. You are in the hospital. Get that through your head. It is NOT like being at home or on vacation. We now call “patients” our “clients” or worst yet, “guests.” Our administrators are much more concerned about if our patients are happy than if they are getting better. My boss is always telling me how much my patients “like me” but I never hear anything about my actual care. It would be better for the hospital’s rating if I let that overweight diabetic eat her ice cream and get really ill rather than tell her NO – at least she would be “happy.”  You know all those high taxes you pay?  They don't even cover the cost of your diagnostic tests and drugs.  You will not get the "penthouse suite" to recover from your CABG. And the hospital will most certainly not fork out the cash for you to have your own private duty nurse who can always be there for you.  You Nurse most likely cannot be in your room for more than 2 minutes at a time without risking lives.  If she doesn't limit herself to a few minutes max with each of her patients at a time she will miss the boat on something big.  And in her line of work it's life and death. 


#8. SOMETIMES IT IS GOING TO HURT. Yes, getting out of bed and walking after abdominal surgery hurts. Pancreatitis? Oh yeah, you are going to hurt and you are not going to be eating anything for days.  You won't be allowed too.  #18 IV in the AC? Yup – it is going to hurt and likely be uncomfortable as hell for as long as you have it. DEAL WITH IT. You are in the hospital. Yes, it sucks and No, I don’t expect you to be happy about it, but don’t constantly whine and complain and demand that I “do something about it.” You are not going to be magically cured just because you are in the hospital, and sometimes there is pain that even high levels of narcotics does not completely eliminate. Walking the day after surgery hurts, but it is the only way to heal, avoid pneumonia, and get out of the hospital.  And if we overdo it with the painkillers you won't move, you won't get out of bed.  Then you will get pneumonia and possibly a fatal blood clot.  No I cannot alter reality. 

So that is part one.  I will be continuing this in part two with "the nurses and doctors did not give your gran dementia, lung cancer and heart failure" and " we have no way in hell of knowing when you are going to be admitted, transferred, discharged or when the hell the doctor or transport vehicle is coming.  Please stop asking.  The amount of time spent away from dying patients to answer your stupid fucking questions that require a crystal ball is a crime against humanity" and also "there are a million and one PERFECTLY good reasons that you or your loved one cannot have food or fluids.  We are not starving or dehydrating  you/her/him to death, the illness is".