chair at the head of the table.
We were meeting in our conference room, also called the break room, located behind the nurses’ station. The room held a small refrigerator, microwave, employee lockers and the ever- warm coffeepot.
All my regular day-shift staff were there while agency nurses—at least this shift we had some experienced ones—were watching our patients. A student nurse joined Tim, Jessie, Serena and Laura, who had been off the day before. Bart and my two evening nurses were missing but Jessie would take responsibility for catching them up on our meeting when she saw them at change of shift.
A nurse for only a year, Laura was on probation with the licensing board. She’d abandoned a patient who had died, but she hadn’t caused the woman’s death. Nonetheless she had to report to the board every three months and I had to submit regular reports on her as well. Her clinical skills weren’t up to speed yet either, and I was beginning to feel frustrated, wondering if she’d ever be the nurse I needed for the fast-paced work in intensive care.
“We can’t keep anyone out if he wants to see them,” I said, arranging my notes in front of me.
“We could if we wanted to,” Jessie said, in a rare display of pique. “Family members only, that’s the rule.”
“You’re right, Jessie, but that’s not the policy anymore,” I told her. “With our census down, we’re supposed to let anyone in the patient wants to see. Just not for long. That’s still true.”
“Any more talk about intubating him?” Tim asked.
“Not at the moment. I convinced Jake to wait until we can let him talk about what he wants done. If he gets a tube down his throat, it’ll just be that much harder for him to communicate. And he’s having such a difficult time accepting his prognosis, I just don’t want anything to interfere.”
“Yeah, but if he can’t breathe, he won’t live to tell us,” Tim said.
“What about his pain control?” Jessie asked, her smooth brown forehead creased in a frown.
“We’re going back to the pump,” I told them. “Judyth got onto Jake after she was up here and Huey told her his pain was a ten. She said we can’t have Huey telling Joint Commission that. So Lord agreed to put it back on and he’s also getting a fentanyl patch.”
“What’s a patch?” a student nurse asked. She had been assigned to Huey that day.
“Fentanyl is a different narcotic, and it’s on a patch that the patient absorbs through the skin,” Jessie explained. “It gives those with intractable pain more consistent relief. It’s noninvasive and better tolerated as well.”
“A pump and a patch?” the student asked.
“Sometimes it takes several different medications to control pain in severe cases like Huey’s,” Jessie said.
“How do you know he’s in that much pain?” she asked, chewing on the end of her ballpoint pen. “He was laughing and joking around when I went in there this morning.”
“That’s the problem,” Tim said. “He’s an alcoholic and it takes more analgesic to relieve his pain, but then again he might just want to get high.”
“Or he might really be in that much pain,” Jessie added.
“Aren’t you worried about him getting addicted?” the student asked.
“It doesn’t matter now,” Tim told her.
“He doesn’t have long,” Jessie explained to her.
“But he seems so alive I just thought...” Her voice trailed off and she lowered her head, scribbling in her notebook.
Jessie patted her shoulder. “Some of them are like that right up to the end. Others are never conscious. It just depends on the person, what’s wrong with them, and on their pain tolerance.”
The student smiled a thank-you to Jessie, and I shifted the conversation to the agenda. I told them to expect the Joint Commission surveyors soon and to just go about their business as usual.
“Now about the union,” I began, glancing at the copies of the union flyer strewn on the
We were meeting in our conference room, also called the break room, located behind the nurses’ station. The room held a small refrigerator, microwave, employee lockers and the ever- warm coffeepot.
All my regular day-shift staff were there while agency nurses—at least this shift we had some experienced ones—were watching our patients. A student nurse joined Tim, Jessie, Serena and Laura, who had been off the day before. Bart and my two evening nurses were missing but Jessie would take responsibility for catching them up on our meeting when she saw them at change of shift.
A nurse for only a year, Laura was on probation with the licensing board. She’d abandoned a patient who had died, but she hadn’t caused the woman’s death. Nonetheless she had to report to the board every three months and I had to submit regular reports on her as well. Her clinical skills weren’t up to speed yet either, and I was beginning to feel frustrated, wondering if she’d ever be the nurse I needed for the fast-paced work in intensive care.
“We can’t keep anyone out if he wants to see them,” I said, arranging my notes in front of me.
“We could if we wanted to,” Jessie said, in a rare display of pique. “Family members only, that’s the rule.”
“You’re right, Jessie, but that’s not the policy anymore,” I told her. “With our census down, we’re supposed to let anyone in the patient wants to see. Just not for long. That’s still true.”
“Any more talk about intubating him?” Tim asked.
“Not at the moment. I convinced Jake to wait until we can let him talk about what he wants done. If he gets a tube down his throat, it’ll just be that much harder for him to communicate. And he’s having such a difficult time accepting his prognosis, I just don’t want anything to interfere.”
“Yeah, but if he can’t breathe, he won’t live to tell us,” Tim said.
“What about his pain control?” Jessie asked, her smooth brown forehead creased in a frown.
“We’re going back to the pump,” I told them. “Judyth got onto Jake after she was up here and Huey told her his pain was a ten. She said we can’t have Huey telling Joint Commission that. So Lord agreed to put it back on and he’s also getting a fentanyl patch.”
“What’s a patch?” a student nurse asked. She had been assigned to Huey that day.
“Fentanyl is a different narcotic, and it’s on a patch that the patient absorbs through the skin,” Jessie explained. “It gives those with intractable pain more consistent relief. It’s noninvasive and better tolerated as well.”
“A pump and a patch?” the student asked.
“Sometimes it takes several different medications to control pain in severe cases like Huey’s,” Jessie said.
“How do you know he’s in that much pain?” she asked, chewing on the end of her ballpoint pen. “He was laughing and joking around when I went in there this morning.”
“That’s the problem,” Tim said. “He’s an alcoholic and it takes more analgesic to relieve his pain, but then again he might just want to get high.”
“Or he might really be in that much pain,” Jessie added.
“Aren’t you worried about him getting addicted?” the student asked.
“It doesn’t matter now,” Tim told her.
“He doesn’t have long,” Jessie explained to her.
“But he seems so alive I just thought...” Her voice trailed off and she lowered her head, scribbling in her notebook.
Jessie patted her shoulder. “Some of them are like that right up to the end. Others are never conscious. It just depends on the person, what’s wrong with them, and on their pain tolerance.”
The student smiled a thank-you to Jessie, and I shifted the conversation to the agenda. I told them to expect the Joint Commission surveyors soon and to just go about their business as usual.
“Now about the union,” I began, glancing at the copies of the union flyer strewn on the
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