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Nursing Lingo Part 3: Frequent Flyers

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“Frequent Flyers” is a favorite nursing term of mine.  I suppose the definition is rather self-evident.  These are the patients that you take care of repeatedly.  Inpatient medicine floors are chock-full of frequent flyers. This could be a young person with Cystic Fibrosis or Sickle Cell or perhaps an elderly patient with COPD* or ESRD.**  On a surgical floor this could be a patient with non-healing wounds.

I like this term because it’s a pretty benign “label.”  The patients are not “the chronically ill” or “sick.”  They are just normal people that happen to frequent the hospital.

Personally, I like taking care of frequent flyers.  They know the ropes.  They also know that they will be seeing a lot of the nursing staff so it makes sense to treat us respectfully.  You just have to be careful that the familiarity doesn’t destroy the professionalism of the relationship.  I had one nursing friend who “fell in love” with a frequent flyer.  Four months later they broke up but he continued to receive his care on our floor.  Awkward all around.   However, caring, lasting relationships with pleasant frequent flyers can really bring joy to your day, and your career.

The down side to frequent flyers is also that they know the ropes.  While the vast majority of my patients are wonderful people, there are always a few bad eggs. The naughty frequent flyers know how to play the staff against one another so stay on your toes!   As soon as you hear, “But last time the nurse let me …” or “But the docs always give me more pain medicine than…”  you can be pretty sure you have a naughty frequent flyer!  As always, treat them respectfully but draw boundaries and stick to your guns!

I enjoy a challenge so if a particularly difficult frequent flyer shows up, I often offer to take the patient.  With the right mix of warmth and boundaries you can convert a naughty frequent flyer to a satisfied and pleasant frequent flyer.   And the icing on the cake? Now your co-workers owe you one!

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*Chronic Obstructive Pulmonary Disease (emphysema or chronic bronchitis)

** End Stage Renal Disease (kidney failure)

Nursing Lingo Part 2: DFO

Nursing Lingo Part 1: Circling the Drain

 

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Run, LuLu, Run!!

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Nicole is a particularly southern NA.  She would honestly say things like “My boyfriend and I work re-po on the weekends,” in as twangy a drawl as you can possibly imagine.  One day she yells to me from the other end of the hall, “LuLu, come!!”  First of all, my name is not LuLu. My nickname is not LuLu.  LuLu is just what Nicole called me because that’s how country she is.

I start down the long hall.

“LuLu!!  Run!!”  I hate running in the hospital.  Nothing freaks out patients (or other staff) quite like seeing a nurse run down the hall.  “LuLu!”

I kick it up a notch and start to jog.

Pamela, in room 17, is no longer in room 17. She’s in Bob’s room across the hall.  Thankfully, Bob is off getting an X-ray.  I look around and put the pieces together.  Pamela had to poo. She got up, wandered into the hall, went in Bob’s room, used the bathroom, and then got in Bob’s bed.  Unfortunately she left a, um, “trail” everywhere she went.  The discovery of the trail was the only reason we discovered quickly that something was amiss.

Now mind you, two hours ago Pamela was a normal, middle-aged lady who knew how to find the toilet and use it.   To you nurses, what would you do next?  Yep, get a blood glucose.  Her “sugar” was really low.  Four juice boxes later, she was back to her old self and had no memory of her exploits.  Too bad I’ll never forget it!

A Nurse’s Prayer

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No matter how tired my feet and sore my back, may I always be grateful that I am the one next to the sick bed, not in it.

No matter the long hours, may I always be awed at the birth of life.

No matter the number of times I’ve seen a body pass into death, may I never forget to grieve.

And Lord, when my time comes and delirium sets in, may all my confusions be pleasant!

All Three

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:::After a patient being a bit fussy with me all morning:::

Me: Are you fussing at me?

Patient: What do you mean?

Me: Well, either you’re teasing me, fussing at me, or being mean to me. Which is it?

Patient: I’m probably being all three.

Me: Um, okay. Please don’t be mean to me.

Haitian Style

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You know you’re in Haiti when:
You see a homemade donkey saddle
The plunger is a natural part of going to the bathroom
When your translator pokes a topless lady in the breast and no one is offended

Defensive Medicine

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Here’s a cute exchange from my facebook wall on defensive medicine.

Me: If I ever get sick, please let the docs practice defensive medicine.

Lauren: What’s defensive medicine?

Me: Let’s say there is a .1% chance I have a very treatable brain cancer and a 99.9% chance I just have a headache. The doc doesn’t think it’s that big a risk that I have cancer so they send me home on advil. Then I die. Sucks to be me.

If the doc was practicing “defensive medicine” he would have given me an MRI. Even though he didn’t think I had the brain cancer, he would give me the scan because he was worried he’d get sued.

Health policy folks get all worked up about defensive medicine because it is supposedly adding too much cost and should be gotten rid of.

For what I pay for my health insurance, copay, etc—- give me the scan. I earned it.

Rick: LOL  at this. There is a difference between a simple headache and headache with other symptoms that point to a neurological pathology. Don’t oversimplify.

Me: It’s a Facebook wall. It was designed for oversimplification of all of life’s Truths.

Rick: Well-played;) Didn’t get that memo.

What I’m Looking For

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Today I had the unfortunate distinction of repeatedly making my patient more uncomfortable.  Other than the fact that the guy is 90, he has another reason to be in pain—a broken bone.  On top of that, he is also constantly cold and despises having the covers pulled back. (He usually has eight blankets on him.)  During my 6 hours as his nurse, he was moved from the ED stretcher to his bed, then on a stretcher to X-ray where he had to sit for a film and was then put back in his bed.  About 15 minutes later he had to be moved back to the stretcher again to go for another test, and then put back to bed again.  He is mostly immobile.  This means that every time we transferred him we had to pull him from the stretcher to the bed and then roll him back and forth to remove the excess linens and pull sheet.  Then his heels had to be floated, a pillow put under one hip, the condom cath repositioned, and his heart monitor put back on.  All this motion had him flustered, uncomfortable, and in pain.  Finally, the last time we were repositioning him, moving the sheet, reattaching things, he sighed and said, “You know, if you just told me what it is you’re looking for in the sheets, I’ll gladly tell you where it is!”