One of the most time-consuming parts of my day in the hospital is finding things. I have stared at the wall of supplies in the storage room, suddenly blind to the piece I need. I have searched all corners of the room trying to find the thermometer, and I have scoured from room to room looking for a recliner I could steal. I have popped to another floor to borrow a bladder scanner or snag an armful of blankets when we ran out. I have sent many, many requests to pharmacy for the one medication that is missing and wait for it to be sent up because a dosage was changed last minute or another piece had just been added.
It takes time. Sometimes it requires several phone calls and traipsing around the hospital to check in a couple of individual spaces. There are occasions where it is better to beg forgiveness than ask permission...or at least sneak it back up into place before anyone seemingly notices. There are also places where trades happen, the you can borrow X if we can borrow Y secret-handshake-swaps in the hallway (temporary exchange of bladder scanner for vein finder was one from a few weeks ago). And if the room that you need it for is a room that requires specific PPE (personal protective equipment, such as a gown and an N95 mask as opposed to a normal procedure mask), then there is a lot of putting on and taking off and back again, and suddenly it is forty-five minutes or two hours later and you are behind on all of the morning meds.
That, of course, is assuming that you know exactly what you're looking for. Let's say that you are not trying to find a particular something but instead you are aiming to solve a particular problem. Then, staring at the wall of supplies becomes a different problem. Here's a hypothetical: a patient cannot have a certain set of medications, they are in pain, and the best immediate solution seems to be attempting a warm compress of sorts, but the warm blankets cool off too quickly and keep sliding off in any case. I ended up taking two ice packs, filling them with warm water, tying them together, wrapping a warm blanket around those, and then wrapping another around the body itself that held the specific limb in place. It wasn't elegant, but it was functional while we were sorting out other details and other options. There have been many, many times when I have walked into a room and thought "what is this hot mess?" only to untangle a pocket of genius that I could refine as the day went along. Other times, it is just a hot mess, and we can scrap the idea to then try something else. Techs, nurses, and other members of the team can find some glorious, creative solutions to so many interesting situations. There are simple questions (How do I take blood pressure on someone whose arms we can't put a cuff on? Use a leg.), there are daily questions (this man's anatomy does not work well with the external catheter--use the other kind but backwards), and there are some that will likely never happen again but still help inform how we approach adjacent questions in the future (too specific to mention here).
This is also assuming that one has the capacity to well identify a the right problem. It's a particular skillset to look at a situation, to take a vague discomfort and turn it into something actionable. Turning a generic frustration into something that you can do to directly address it, that takes a certain amount of critical thinking combined with active listening--it's easy to latch on to one part of the conversation while ignoring the core. This also takes time, to suss out a series of complaints into steps. The real secret, though, is that the core has to be identified, even if it cannot be acted on directly. It needs acknowledgement. Solving a couple of the smaller pieces can help, but simply acknowledging the core tends to help much, much more. A very common one I see in my patients is that they feel out of control in the situation. If I interrupt the first part of the tirade where the patient complains of being cold by offering a blanket, then we might not get to the real reason of the frustration. It's important to listen fully, and it's difficult to be patient enough to do so. I tend to let them list out everything and then repeat back parts with "So what I'm hearing is..." to check for clarity, allow for additions, and then end the conversation by validating their feelings and repeating the list of actionable steps we have made. As long as I can fulfill my verbal contract or keep them updated on ways it could not be, I have earned their trust.
Now, in addition to solving an already existing problem, there is an additional skill--preempting potential or even related issues. This is an entirely different skillset and frankly it is an artform. It is a very helpful one to have in nursing, most certainly. Can I deescalate a patient's feelings of lack of control by offering small choices, like whether they would like their door open or closed? I can also call them before I go into the room to see if there is anything else I can bring with me before I go in, saving myself a trip in addition to allowing them voice into the situation. They keep asking for water when I go in, so maybe I can bring a fresh one in with me anyway. Again, it takes a certain kind of mental energy, intentional forethought to put myself through possible hypotheticals of what I might need and then see if they might also fit for the patient's circumstance. I should also be considering potential issues in the room, such as whether the path to the bathroom would be clear if they had a sudden emergent need. Is their phone charger plugged in and in reach?
All of these facets are using different levels of critical thinking, on top of that other critical thinking that I need to do, like watching trending vital signs for new potential issues.
So, long story short, at the end of the day, my brain hurts.
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