Saturday, February 19, 2011

What I did today…and what I did today that is actually in my scope of practice

1.)  Chest physiotherapy.  Lots of chest physiotherapy.  Percussion, deep breathing (assisted by enthusiastic crying…which was also assisted by nasal and oral suction).
2.)  Made two post op open-heart surgery children walk around the ICU despite their frenetic protest. 
3.)  Attempted to put a Foley catheter in one of the screaming children mentioned above who refused to, or more likely was unable to urinate…I failed but she peed, so whatev.  
4.)  Changed a central line dressing.
5.)  Changed several sternal incision dressings.
6.)  Obtained peripheral IV access in as screaming three year old.
7.)  Mixed up my very own Lasix drip (Oh, and YESTERDAY, I got to mix an epinephrine drip!)
8.)  Terrorized my lovely Intensivist Nadia by making her assist me in executing all the aforementioned “nursing” tasks.
9.)  Pulled two central lines and one art line
10.)    Pulled mediastinal chest tubes for the first time.
11.)     Pulled pacer wires for the first time (mostly because Nadia refused to do it because she said it was “mean”….probably because we didn’t use propofol).

I wore gloves for some of these tasks…(well, one actually) but I think I will edit the details of my general non-compliance with universal precautions.  There are two boxes of gloves that I have seen so far in the ICU…and I am not sure if more will materialize should we use them all.  Plus, after the event last night…I think I would prefer to save the limited number of sterile gloves for direct cardiac massage…i.e. putting your hand in a kids open chest to pump their heart (yep, that really happened…in the ICU…last night). 

Most of this stuff I am actually completely qualified to do…well, I think I am at least.  At my home center our cardiac surgical PA definitely pulls all the mediastinal tubes and pacer wires, so those are nifty new skills I have acquired on this trip.  However, the Australian nurse I have been working with does that sort of thing all the time back home.  Same story with the mixing of drips…I have never in my nursing career had to mix anything other than sterile water with ampicillin.  I have required a lot of hand holding for these tasks in particular…epinephrine and heparin drips are two that I would prefer not to screw up. 

The pulmonary toilet stuff…well, totally within my scope of practice but almost never expected of me clinically due to the prevelance of respiratory therapist is back in the States.  Not hard though.  Good skills to refine.

But my favorite part of all this: NOT CHARTING

In Stateside medicine we end up spending as much, if not more, time documenting everything we do then we actually spend doing it.  Much of this is an unfortunate byproduct of the litigious nature of our country.  If anyone can “blame” you for anything that goes wrong, you need to be constantly proving that you did everything right…hence to meticulous and voluminous documentation that anyone working in healthcare in the States is familiar with. 

This is not to suggest that there is any change in the level of accountability; the difference becomes personally inflicted in a sense.  I care about doing things right because I care about doing things right….not because I am worried about getting sued. 

For me here in Iraq, it is all nursing.  It is all patient care and teaching and collaborating with my team.  I love working side by side with an intensivist who knows everything about the ventilator, can help me calculate doses and drip rates, and will help me place the Foley catheter that they just asked for.  I love working with other nurses who have skills that I may not but who are happy to share those skills with me so that I can teach the local staff.  I love trying to figure out how to do something without the resources I am accustomed to…only having six syringe pumps for the whole unit, or not having the syringes or variety of various specific tubes at my disposal. 

The bottom line is that we all do our best with what we have.

And I like that…if feels like real medicine. 


  1. And in the process I am sure you are becoming an even more remarkable nurse than you already are. Wow. What a day!

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  3. Reminds me of working with open hearts in PICU back in the day (30 years ago)in Arizona. I'll always remember the bedside open chest CPR we did one night on a toddler and then getting a picture of her blowing out 4 candles on her birthday cake. Priceless.
    You will have these memories of your nursing experiences forever. Knowing you saved a child's life and made a difference today is affirmation that this is your true calling.
    Way to go Kristen...this is what you were meant to do!!

  4. Kristen,
    I love reading about your adventure. When you said you feel like you are practicing "real" medicine that is exactly how I feel when I go to third world countries. The fact that you have to brainstorm and be creative because of the lack of resources is why I love it so much.

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