the ideal nurse

In my practice, I am privileged to work with many highly skilled nurses. They are critically important to the well being of my patients. If you have ever been in the hospital, you know that the nurse spends a lot more time at the bedside than the doctor does. I depend on nurses to know their patients and to be my eyes and ears and brain when I am not there.

What qualities do I look for in a good nurse? I’ll tell you, in no particular order.

The best nurses have great bedside manner. They are able to juggle the needs of the patient, the family’s concerns, and the doctors orders and still project a calm caring manner.

Organized thinking is critical to good nursing. They are the coordinators of patient care. They administer to the direct patient needs. They organize ancillary services. They help communication between various physician specialties. Dozens of little pieces need to come together to assure the best outcome for a patient. Good nurses are masters of making that happen.

Sound clinical judgment is another vital quality. The nurse is at the bedside and has pretty good idea how their patient is doing over the course of their shift. All the measurement of vitals and recording of data don’t mean much without skilled clinical assessment. If an experienced nurse calls me and simple say’s “He doesn’t look good.”, I know we need to take action.

Speaking of calling me, the best nurses know how to communicate with me over the phone. They can organize their concerns, present data to validate their assessment in coherent fashion, and have their own ideas about what needs to be done.  A simple example is a call about low urine output. The skilled nurse will say “Mr. Smith’s urine output has been low for the last few hours. His intake has been greater than his output all day today. We have him his blood pressure medications earlier, and his blood pressure is a little low. His kidney function is normal. I hear crackles in his lungs and his ankles are a little swollen. Can we hold his pressure meds and give him some Lasix?” A less helpful call would be “Mr. Smith’s urine output was less than 30cc in the last hour,. so I’m calling you.” See the difference? The first nurse knows what the patient needs and presents me with the information I need to give the right orders. The second makes me go on a scavenger hunt.

In order for the nurse to communicate the patient’s condition to me, he or she needs to have all of the information. A good nurse is obsessive about details. She will know the patients history, current labs, vital signs, medications, and previous problems and treatments. He is meticulous in following the clinical pathways for patient care.

Independent thinking for nurses is a little more difficult. Regulations in the last 20 or 30 years have restricted nurses’ activities in patient care to an unreasonable degree. Here is a highly educated professional who can’t even decide to give a Tylenol without a physician order. However, the best nurses are able to work within these restrictions. They anticipate patient needs while I’m making rounds so that they can ask me for that Tylenol order before the patient needs it. They are experts at following the proven clinical pathways that allow them to give the patients what they need using pre-established protocols. They what is of immediate importance and what can wait until next time I’m on the phone or making rounds.

I’ve gone on a bit, but that’s an indication of how important my nurse colleagues are to me and my patients. When you have a good nurse, appreciate that and thank them. Write a note to the hospital complimenting their care. They don’t get enough recognition.

Comments

[Judy Casper]

Brilliant!
Couldnt have said it better myself!