On the Other Side of the Rails


Still a Nurse: An Unexpected Journey of Hope Part II

Deb Jeffries MSN-Ed, CEN, CPEN, TCRN, FAEN

Still a Nurse: An Unexpected Journey of Hope Part I
Photo Credit: http://istock.com/Juanmonino

Nursing 101: Does it Matter?

Graduation from nursing school requires students to successfully complete a standardized and rigorous program providing the foundation from which to build their nursing practice. Although specific content may vary from one RN program to another, there are commonalities seasoned nurses may refer to as “Nursing 101.” These skills include, but are in no way limited to, the safe administration of medications, assisting patients to ambulate, calling them by their surname until given permission to use their first name, and making sure the patient has the call light within reach. Sometimes as nurses become experienced their behaviors do not always reflect the importance of employing these basic “Nursing 101” skills. Perhaps during our journey from novice to expert we lose a bit of the urgency associated with basic nursing as our focus shifts to the more complex aspects of patient care.

As one would expect with any ICU stay, there are many low points and a few high ones. Getting out of bed for the first time was definitely a high point. Perhaps it is normal for the low points to be clearer in my memory given what I was going through; high flow O2 at 60 liters to keep my pulse oximeter in the high 80% range, feeling like every breath would be my last, staring at my cardiac monitor watching my rhythm and pulse oximetry readings, and having multiple lines hooked up to my implanted port.

For 2 months I received daily radiation (Monday through Friday). Because my condition was so unstable while I was in the ICU, my radiation treatments required Advanced Life Support transport via ambulance despite the radiation center being on the hospital campus. I was shunting and experienced heart failure, a large pleural effusion (more than 500 cc removed during an emergent thoracentesis), and a complete “white-out” of my left lung on chest x-ray. This “white-out” indicated that my left lung was not functioning. In addition to many other interventions I received, I was given 80 mg of furosemide through one of my central lines at 10:00 PM on my third night in the ICU. This diuretic medication rapidly began working and a short time later I had an overwhelming need to urinate. Being the compliant patient that I tried so hard to be, I looked for the call light, but it was nowhere to be found. I had no strength or pulmonary reserve to be able to yell for help. I saw a bedside commode near the end of the bed so I did exactly what patients are not supposed to do – I tried to get out of bed. My oxygen saturation immediately dropped into the 60% range causing an alarm to sound which brought the nursing staff to my bedside. A nurse actually yelled at me for trying to get out of bed. I wanted to retort, “But I didn’t have the call light,” but was unable to speak. Please always remember what we perceive as patient noncompliance may be something more than willful disregard of the “rules.” I was desperate to maintain some control and dignity, and there was no way I was going to intentionally allow myself to urinate in the bed. At that point, there was a lot of chatter about things like “intubation,” “but we’ll never get her off the vent,” and “what do you mean she is not a DNR?” A nurse told me they would insert an indwelling urinary catheter and that I should not “fight it” as it was for my own good. I was astounded because in my opinion, inserting the catheter before administering the diuretic would have been appropriate given the severity of my condition.

I realized after I reflected on this experience of needing help and not be able to get it that I felt at times angry and at other times sad because what I went through that day was avoidable. Does “Nursing 101” matter? Unequivocally it does, as not having a call light nearly killed me. No matter how long we practice nursing, we must never lose sight of the importance of “Nursing 101.” We must use this foundation of basic nursing with every patient encounter, every time, and this includes in the emergency department setting as much as in any other area of nursing.

Stay tuned for Part III of this series:
Still a Nurse: An Unexpected Journey of Hope Part III
Going Home

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Guest Contributor

Megan Doede
Deb Jeffries MSN-Ed., CEN, CPEN, TCRN, FAEN

Deb has been an emergency nurse for 38 years and was recently inducted as a Fellow in the Academy of Emergency Nursing (class of 2021) for her enduring and substantial contributions to emergency nursing. She is certified in emergency nursing (CEN), pediatric emergency nursing (CPEN), and trauma emergency nursing (TCRN). Additionally, she is an ACLS, PALS, and BLS instructor.

Improving the knowledge and skills of nurses caring for pediatric patients is an area she has been passionate about for many years. She has been an ENPC instructor for approximately 9 years and a course director for approximately 5 years. Deb recently co-authored the book Rapid Access Guide for Pediatric Emergencies: Providing Expert Nursing Care as a resource for nurses to use at the bedside.1 Deb has been committed to the standardization of the care provided to children for emergency nurses especially in general population emergency departments. She has also done podium presentations, podcasts, and webinars on the care of children experiencing an emergency.

Deb has been involved in trauma education for trauma and emergency nurses for decades. She has been a TNCC instructor for approximately 9 years and a course director for approximately 6 years. She was selected for a Poster Presentation for the 2021 Trauma Center Association of America (TCAA) national conference for the project spearheaded at a Level 1 (ACS) trauma center: ATCN and TNCC: Are They Enough? Innovation, Interaction, and Intentionality in Delivering Trauma Orientation Education for Nursing Staff.

In addition to these accomplishments, Deb has made a significant impact on the advancement of emergency nursing. She dedicated much of her career to clinical education in the emergency setting and has contributed globally to the standardization, process throughput, and implementation of best-practices for emergency department triage. She is a passionate advocate for standardization of the triage process and education and has provided triage education nationally and internationally.

1. Jeffries D, Visser L. Rapid Access Guide for Pediatric Emergencies. Springer Publishing; 2021.

How to contribute

We encourage submissions from any reader who has been touched by the healthcare system. Some contributors may be involved directly in patient care and might want to share the impact a patient, family, or colleague had on them. Others may want to write about life “on the other side of the rails” …those moments when the caregiver becomes the patient…or maybe sees healthcare from the vantage point of a family member. Inquiries can be sent to [email protected]

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