Friday, August 5, 2016

Bedside Nursing - Survival Tips

Bedside nurses are favorite targets for abuse from patients, doctors, and administrators. One of the local hospitals here in Pittsburgh is known by the initials AGH. The nurses there swear the initials stand for "always getting Hell." Nursing can also drive you nuts with profound questions like, "Why did 2 similar patient problems end so differently?" One patient recovers, the other experiences every known complication. Every bedside nurse devises strategies to deal with these soul sucking matters.

One of my favorite sanity maintenance tricks was to find secret hiding places or SHP. These were places to catch your breath, regroup, and refresh. Sometimes just a minute or two in a SHP worked wonders.

I mentioned this one before, but it was one of my favorites. No matter how stressful or lengthy the surgery one arena of profound peace is that under the OR table sanctuary. The drapes form a cozy tent in the middle of the forest feeling and even the harsh noise and lighting is muted. The most challenging trick is to find a reason for crawling under there. My favorite ploy was to tape down the foot pedal of the Bovie. Unfortunately, this only worked in the neuro room where a Mallis bipolar foot actuated cautery was used. The old " I'm going to have to investigate and make sure there are no kinks in the suction line running under the table," worked well in a general surgery room.

Sometimes when everyone is hypervigillantly involved in a tricky procedure the circulating nurse can simply duck under the table sans explanation. If someone does ask where the circulating nurse is simply reply "I was just checking for sponges under the table, You can't be too careful."  While under the table take a few deep breaths in time with the Airshields anesthesia ventilator and you wil soon feel renewed and refreashed. Those old Airshield ventilators used to make the most soothing inhale - exhale noise as they cycled.

Remember that peaceful  John Denver tune, I think it was called Annie's Song. Well that song used to run through my head while enjoying that under the table peace. John's lyrics were "You fill up my senses like a night in the forest." I used to hum his tune and think, "You fill up my senses like a spell under the table."  Ahhh, peace at last.  Now I'm refreshed and ready to face all the mayhem on the topside. "Four units of blood STAT? Coming right up Dr. Salmbow."

Scrub nurses had  a SHP that was in plain sight. The good old scrub sink. That soothing warm water cascading down and the rhythmic scrubbing was as good a relaxation technique you could find. Nurses always scrubbed long before the time pressured surgeons showed up so enjoy this not so SHP before each case and pick a sink with a view. Your nerves will thank you as soon as the surgeon starts complaining about how obese the patient is and why don't you have extra long needle holders.

The operating rooms were serviced by an old non automatic elevator that was manned by a whacky operator during the day and whoever was on call during off  hours.  There was always lots of drama in the elevator car with a hot trauma case or as Dr. Slambow used to refer to them as a "good" trauma.  I never could figure out what was "good" about trauma, but that tale will have to wait.

 I remember one patient that had a laryngeal injury from a car wreck on Lake Shore Drive. A trach had been performed in the ER, but air was leaking past the trach creating a nightmarish bubbling noise. It really jangled my nerves. As soon as the patient was in the OR, I noticed how peaceful the vacated elevator car was. All I had to do was run the car down 1/2 floor to prevent interruptions and indulge in that relaxing purr of the old brass ventilator fan. Ahh.. Serenity at last.

Linen closets were also a perfect SHP. The quiet was insured by the muffling action of stacks of sheets. The scent of clean sheets was also a nice contrast to that GI bleeder passing stool that would peal paint or make your nostrils burn. Linen closets were often centrally located on the wards so as to be easily accessible. I rate linen closets 4 stars as SHP.

What could be better than a field trip combined with a secret hiding place? After a shift in the OR fighting with surgeons it was always a pleasure to journey down to the basement with a load of trash to be incinerated. The incinerator room was impressive. It was  a concrete block building with a glowing hot guillotine type door. This glowing hot door was operated by stepping on a foot pedal.

The best part of this SHP was the incinerator operator named Ernie. He was a huge black man that was always in a jolly, uplifting mood. Ernie acted as though I was one of his best friends. He said encouraging words like, " You must really be a good nurse. You are working with the top surgeons at Chicago's best hospital." What a nice change of pace from Dr. Slambow complaining about how I cut ligature or that my Babcock was too short.

Ernie was always drenched in sweat and I could never figure out why he was always so euphoric. What a wonderful change of pace.

This post is getting too long and my arthritic fingers are acting up. It must be time to seek out my secret hiding place. Thanks to you for reading more of my foolishness.


  1. Have I mentioned how much I love this blog? It's interesting and funny. I don't comment that often but just wanted to let you know that you have readers out here who appreciate what you write.

  2. Thanks so much for the encouragement. My initial goal for this blog was to winnow down my piles of old nursing care plans, memos and just plain junk left over from my years as a nurse. I still have my junk pile, but I'm glad to share me foolish stories.

  3. There are fewer secret hiding places in my modern clinical bedside nurse world. My job requires wearing a locator so that every minute I am in the hospital building, with a few clicks, everyone knows where I am at all times. Occasionally I get respite when I volunteer to pick up blood products from the lab or something from pharmacy that can’t be tubed.The nifty Big Brother locators have a limited range.
    I loved this post, and identified with much of it.

    1. Old hospitals did, indeed, have quite a few secret hiding places. When our old OR moved into our new suites the entire former site was undisturbed for many months. Todays hospitals are so focused on money making that nothing is left vacant. You can tell what god thinks about money by observing the people he gives it to.