As a nurse, one’s career is often precast, shaped, and resolutely sculpted by solitary and random moments in one’s line of duty. These moments are significant since they help one learn and grow. Sometimes, these moments may positively impact one’s desire and commitment to saving more lives (Roberts & Grubb, 2014). Also, these moments may not have desirable influences on the career of some nurses as they could make one want to quit their jobs as nurses. It had been two years since I was first assigned to the cardiac trauma step-down unit at my hospital and I was only beginning to become self-assured of my proficiencies and acquaintance. In the step-down unit, my job involved dealing with a group of patients suffering from serious illnesses and conditions, for example, victims of motor vehicle accidents, those suffering from heart failure and chest traumas, ventricular dysrhythmias, ruling out heart attack patients, and also those complaining of ordinary chest pains. The standard chest pain rule outs I would say, were the easiest group of patients to look after.
Most of these patients would first go through the emergency room where they would go through routine assessment, blood work and electrocardiogram (ECG), and in case indicated, would be passed on to our unit. Once in the cardiac step-down unit, our work was to complete testing their serial enzymes and also monitor their health progress. Those whose enzymes tested positive would stay a little longer with us to receive further care. However, those whose enzymes were negative would be relocated to the medical-surgical section. In the general medical and surgical section, the patients would undergo both upper and lower gastrointestinal workup, or sometimes they would be discharged and asked to report back to the facility for further tests on later dates.
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I was working shifts between 6 p.m. and 3 a.m. and I was just beginning to work my first night out of five more to follow. As usual, I had to take care of a group of patients, and on this particular evening, I had three under my watch. The first patient was in the final stage of heart failure, another was suffering acute pancreatitis, and the third and who was closest to me since she had been at the hospital longer than the other two, was an obese mother of two with a health history of both hiatal hernia, and hypertension. She had been admitted to the facility two days ago; the day of my last shift the week before, complaining of chest pain. On that day, her ECG and serial enzymes tested negative, and for this reason, the lead physician suspected she could have been suffering from gallbladder disease. Of the three patients I was assigned to, I would say she was my easiest responsibility given the fact that her situation was less severe than the other two.
Two hours into my first night shift of the week, the third patient’s last set of serial enzyme test results were sent in, and as expected, the results were negative. Following the test results, the focus was now to move ‘the third patient’ to the medical-surgical section as soon as we found some bed space in the unit. When I reported to work earlier that evening, the third patient was assigned a private room in the step-down unit, so when I disclosed to her the news that she would be transferred to the medical-surgical unit probably that night, or early in the morning the day after, she inquired if there was a possibility she would secure another private room there. Maybe she loved hosting her many visitors, and I had noticed when I first stepped into her room that she had more visitors than the hospital permitted, privately. Maybe she wanted to be eating her chicken with some privacy. However, not the best food to eat when having gallbladder disease, she was yet to completely rule out so I let it slide. Unluckily, there was no private room for her this time round.
As I was handing over the third patient’s laboratory report to the medical-surgical unit, she put on her call light and said that her chest pains were back. As I rushed into her room, dragging the 12-lead ECG machine along with me, I said to myself that her pain must have been caused by the bucket of fried chicken I let her eat even though I knew it was not the right food for her. For a moment, I hated and blamed myself for what she was going through. It was all my fault. However, I still had a life to save so I shelved the regrets and performed a 12-lead ECG, gave her sublingual nitro, and called the physician. The physician ordered that another serial enzyme tests be conducted and also cancelled the order to transfer the patient to the general medical-surgical unit. The patient did not complain of the chest pains again for the rest of the night and I felt relieved.
As I walked into the step-down unit on the evening of my second night shift, I thought the third patient must have been transferred to the general medical-surgical unit already since it only took a few hours to complete the serial enzyme tests. Besides, securing bed space in the general medical-surgical unit was quite easy, and especially during the day. However, that was not be it, she was still there in her private room, this time round enjoying cheese and French fries. I thought it was not to the best of her interest to be eating such meals and especially now that she was scheduled to have a gastrointestinal (GI) workup. I gently suggested so but she gave me a cold look, and for a moment, I dropped the nurse tag and only wanted to mind my own business.
A few minutes into my second night shift, I secured a bed for ‘the third patient’ in the general medical-surgical unit. I wore my happy face and walked into her private room to tell her about the good news. She would be going home after the GI workup after all. I was to have her transferred to the general medical-surgical unit in the next ten minutes. However, just as I left her room so as to hand over her report to a general medical-surgical unit nurse, the third patient’s call light went on. She was having chest pains again. At this point, I thought to myself that she was being manipulative. In some cases. patients present with certain conditions which are not clear to the nurse, hence demanding immediate attention by the physician (Sarafis et al., 2016). In my case, the patient must have been faking the pains so as to maintain the comfort of her private room, or she was trying to avoid something, so I thought. I reluctantly dragged the ECG-lead machine into her room again, went through the same protocol as the night before, and as the nurse before me during the day. The results were the same as to when I first responded to her call: she never complained again during the night, and her transfer was withheld. She seemed happy with the results. I did not however share into her feelings, I was annoyed and angry at her. I had legitimately sick patients who needed my attention but she could not let me give them as much of my time as I had wished.
As I entered into the hospital in the evening of my third shift, thoughts of the third patient polluted my brain. I really hoped she was not there anymore. I really hoped she was discharged or already in the general medical-surgical unit. That was not to be it however. She was still in the step-down unit, still under my care. I swore to do nothing in case she complained of chest pains that night. To me, it was now clear that she was only playing games with the hospital administration and using her wit to make trivial requests. After routine checkups on the two other patients, I handed the third patient’s report to medical-surgical unit and immediately began packing her medication. It becomes increasingly stressful to ensure that patients are doing fine and that they have no issues as pertains to their stay at the hospital. Therefore, nurses are prompted to use various strategies to deal with varied patient issues (Jordan, Khubchandani & Wiblishauser, 2016). In the case at hand, I even lied to her about a nice room we had found for her so that she could make my work of helping her to the wheelchair easy. After she was well seated on the wheelchair and I thought she was comfortable, she began complaining of chest pains again. I had however decided, the medical-surgical unit was going to be the next stop regardless of whatever that was going to happen.
She took a deep breath and went calm. I noticed that her skin was gradually getting moist and that beads of sweat were forming on her upper lip. How could she be so perfect at faking sickness? I thought to myself as I helped her back to the bed and stormed into the corridor to collect the dinosaur machine. I hated myself as I pulled the machine into her room for the hundredth time in three days I thought. Trying not to seem angry, I reluctantly attached the suction cups and as soon as I was done, the unlikeliest of things happened. I saw the highest ST elevation I have ever recorded on n ECG machine. Her heart stopped pumping right before me. I hurriedly called for help and then immediately rushed her to the cath lab. Here, it was established that her right coronary artery was entirely blocked. The doctors were however able to stent her and save her life. I had saved a life in the most improbable of manners I told myself.
To this day, I still appreciate the impact ‘the third patient’ had on both my personal and professional life. Personally, she made me learn that however much self-assured I can be sometimes, I am not always right. Professionally, she made me humbler also taught me to accept people for what they are and not what I think they should be. She influenced my career and today I believe that my main responsibilities as a nurse are to give the best care I could to everybody, also teach and be a source of progressive influence to my patients. Additionally, I also got to appreciate protocols more. There is power in protocols and for no reason whatsoever should medical practitioners fail to do as promulgated by the medical protocols. I believe I am a better nurse today, thanks to working with ‘the third patient.’
Finally, regarding measures I took to overcome the stresses of the event, the first thing I did was requesting for time away from work. I used this time to assess what was best for me, and when I finally made the decision to return to work, I knew I was returning as a changed individual with the commitment to save lives. I also visited ‘the third patient’ at her home days after she was discharged from hospital. When I returned to work, I used my experience to urge other nurses to be taking their work seriously and always be serving the interests of their patients however much irritating they could be. We are all likely to encounter a patient more like ‘the third patient’ in our career, and if we do not take them seriously, we will end up losing several lives and that could have been easily saved.
References
Jordan, T. R., Khubchandani, J., & Wiblishauser, M. (2016). The Impact of Perceived Stress and Coping Adequacy on the Health of Nurses: A Pilot Investigation. Nursing Research and Practice , 1-11. doi:10.1155/2016/5843256
Roberts, R. K., & Grubb, P. L. (2014). The consequences of nursing stress and need for integrated solutions. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses , 39 (2), 62–69. doi:10.1002/rnj.97
Sarafis, P., Rousaki, E., Tsounis, A., Malliarou, M., Lahana, L., Bamidis, P., … Papastavrou, E. (2016). The impact of occupational stress on nurses' caring behaviors and their health related quality of life. BMC nursing , 15 , 56. doi:10.1186/s12912-016-0178-y
