As many of you know, about six months ago, I made a transition in my career. I’ve loved geriatrics, but I started to feel like I needed to try new things, and push myself as a nurse. It’s been quite a transition, and I’m pleased to say that I’m starting to feel like I’ve got my own pace now, and things are great.
What’s been most fascinating is the transition from thinking like a long-term nurse to thinking like a hospital nurse. There’s still a few habits that I need to drop, but I’m definitely doing better.
One of the biggest adjustments has been my relationship with doctors.
In skilled nursing, your patients are fairly stable. Even those who are on the TCU or rehab side of things, they aren’t critical. You’re not going to be doing blood draws on them every day, and you aren’t going to be monitoring for a catastrophe. You’re really in the mindset of reporting any abnormalities. Along the same lines, most of the patients in a skilled facility are going to be the patients of the same doctor. One who usually has several other jobs, which tend to take priority. The biggest decision a nurse can make is:
Is this worth bothering a doctor for?
Usually, the answer is no. Especially when you’re working night shift. Even then, I’ve worked in enough facilities that I’ve had multiple doctors give us the instructions that anything he needs to be contacted about should be given to him in bulk. A patient wants eye drops? Hopefully you can wait until the doctor comes in… in three or four days. Patient’s weight fluctuating? Well, the doctor will be in on Wednesday. Hopefully they don’t lose too much more. We’ve had doctors request that we don’t call them for anything, except an emergency, and even when a patient dies, half of the time, we can’t get a hold of their doctor.
In the hospital, that’s not how things work. You’re always communicating with the doctor. If you’re wondering if you should report something to the doctor, you’d better stop wondering and just report it. Any small changes could be an indication of something bigger. Suddenly, I have doctors actually asking me about a patient, asking their latest labs, their vitals, how much they ate, things that they need to know to make sure the patient can heal enough to get back home.