Wednesday, August 20, 2008

Nurses and doctors

"CRASH in Bed 2!!! Get the crash trolley now!!!!". Everyone's heart races to the max, and only nurses are to be found at the scene. "No heart rate. Start CPR!!" So, with me close by, I initiated the cardiac massage. Another nurse rushes off to beep the doctor on call, while another is pumping air via the Ambu Bag(Respiratory Bag with Oxygen Filled). A few other nurses co ordinating the drips and pumps that's infusing into the patient. Within a few minutes of cardiac massage, my arms are already getting tired but there's no way to stop the massage when there's a life at risk. The cardiac massage are quick in counts of 2 pumps in less than a second.

The doctor arrives, patient still hasn't 'woken' up. One doctor available. That's it. No junior doctors, no consultants, just one, at the scene. So, all nurses present would just have to play the part of junior doctors at hands.

The pressure to revive the patient is unbelievable. My colleague helps the doctor to put on his theatre gown in preparation for invasive procedure. The patient being intubated and all, still hasn't got a heart beat. " CHARGE!!!.....CLEAR ...EVERYONE STAND BACK !!!" Patient given a defibrillator shock by one of the nurses.

Still no heartbeat, and I'm still pumping away. " ATROPINE....NOW!!" says the doc. "CHARGE AGAIN!!!! ...CLEAR...I SAID ....CLEAR!" Everyone stands back this time, and a second shock is delivered.
.......A rhythm on the cardiac monitor, ...."Somebody, check the pulse.."

All I can think of is the patient's family. 'Please let him live'

"Pulse present. Stop cardiac massage. Get the family here" ..Even when the heart has started pumping, patient's blood pressure still low and unstable. The mess is terrible around the patient's bed. Floor covered in spilt blood and other fluids. A disaster area, a fall would be inevitable. All nurses are still runnning like loose chickens to either prepare more drips, trolleys for more invasive procedures or documenting the whole series of minute event on the charts.

This has been the scene at the previous hospital where I worked as an intensive cardiac nurse. It was always one minute to the other, having to revive and stabilize patients. But the adrenaline rush kept everyone going. My problem working there was not the stress that came along with the job, it was more of how the doctors and management treated us.

It didn't matter if you stood on your feet for 12 hours, working non stop, having probably less than an hour break. It was management thinking all nurses under them should work 'round the clock' and still be underpaid. Funny how they will manage to tell the nurses there weren't money for bonuses or extra pay rise in salary. And yet, brand new equipments (non medical) or office furnitures or new designs of nurses uniforms will be purchased shortly after the statement.

It's not so much of money that nurses are after, just gratitute and appreciation would suffice. Problem is, nurses in South East Asia, I feel, are still undervalued and certainly in this country, not well respected.

I read in the papers about promoting nurses education. I do hope it takes place pro actively. I have rarely found a doctor around here, respecting a nurse for what she is. It still frustrates me how doctors and other specialists disrespect and verbally abuse their nurses. And the sad thing is, they get away with it.

I used to work in St Mary's in London Paddington and have worked with top great cardiac surgeons. It was such pleasure to work with them. They talked on the same 'par' with us and have always listened in to nurses decisions and opinions. We even called them by their first names regardless of our status as junior or senior nurses.

If there were anytime of nurses not having breaks, doctors would have chipped in money to get us burgers and drinks for lunch or dinner. Well, just count on your bottom dollars the doctors here will be asking why are you even taking a lunch break.

Not all doctors are that bad. But they are very rare to find 'here'. Their bedside manners are definitely something to improve on.

I guess if managers of hospitals can take priority in giving their full support to their nurses, doctors would probably follow the lead. In return, the nurses would have to find their voices when addressing medical issues or opinions to doctors without fear of retaliation.

There is a strong 'Who's to blame?' culture among nurses here, rather than 'looking' into why and how the incident took place. Pointing fingers still plays a big part in the medical professions here in hospitals and until they can move forward from the blame culture, no profession is going to learn from what they already do know. If nurses stay submissive to doctors and doctors still retain their 'ego' mindsets, only the patient has so much to lose from a system that's still in it's victorian days.

1 comment:

Anonymous said...

Hi!! I think the blame culture is everywhere in Brunei - not just in the medical profession here. I come across it all the time at UBD/ITB....ugh......really annoys me. People in the workplace haven't grown up here, it's still a world of adults acting as if they're in kindergarten. Instead of solving a problem, it's sooo much more important to blame someone else. Doesn't matter if the problem is left unsolved for the next 50 decades, does it? As long as you have someone to blame, or a system to blame, everything's absolutely FINE!!!
Nice blog by the way. I like reading blogs.
Atiyah X