Leaving Bedside Nursing

My journey away from bedside nursing was fueled by an overall feeling of helplessness. This overarching theme continued to present itself. 

Firstly, in caring for patients who were admitted repeatedly. In healthcare these individuals become known affectionately or begrudgingly, depending on the individual, as “frequent flyers”. These are the patients who come to the hospital over and over because of poor management of their chronic conditions such as lung disease, heart failure, diabetes, or liver disease.

On one hand, there is the familiarity and relationship between the patient and staff. Their medical history is known by the hospital, and the patient knows what to expect. The care team is aware of their preferences so typically the admission and hospitalization would go smoothly. They are taking their medication consistently, their dietary and fluid intake is managed by the hospital, and they have assistance with their daily activities. Within a few days, they are feeling better, ready to leave the hospital. 

At this point, as a nurse you deliver discharge instructions to the patient. Medication changes are reviewed, follow up instructions are provided, and questions are answered. I found myself wanting to be very detailed with this responsibility because it seemed like so much could go wrong to cause the patient to need to be admitted all over again. Could they afford their medication? Who was going to help them get to their appointments? Were they going to remember the lifestyle changes we discussed? Do they have the equipment they need at home? I had so many concerns about how the plan on paper would be carried out once they were back in the real world. 

Sometimes, a couple weeks would go by and then the patient would be admitted to the hospital again. Other times, it may be a longer stretch and they have not been admitted. “Is it a good thing? “I would wonder. “Maybe they’re doing well…unless they aren’t. Did they pass away?” It was hard to not know what happened to the patients I came to know well. This gave me the desire to be more involved with a patient’s ongoing care ; in the primary care environment I could follow the same patients and be kept up to date with their health status and needs. 

A second scenario that had me feeling helpless and wanting more autonomy was the fact that nurses with a bachelor's degree education are unable to write orders for their patients. For example, a patient who has a headache and needs Tylenol, or when someone has a sore throat and asks for a lozenge. It felt ridiculous to need to get permission to give these types of treatments. Knowing what a patient needs, and having to try to convince someone on the other end of the phone that they need it was defeating. Some providers do not want to be bothered, a handful will not take an opinion of a nurse no matter what, while others are receptive to hearing the concern. 

As nurses, we advocate for our patients as best we can, but ultimately the decision to make any changes lies with someone else–the physician or advanced practice provider. This could be as simple as the examples above, or life changing like the one particular night shift that stands out in my mind. Nurses are the ones in the hospital who are at the side of our patients. We see changes occurring in real time. We know what symptoms present early before there is an emergency, yet outside of an emergency situation we cannot provide treatments that are not yet ordered. This night had me feeling more helpless than ever.

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