A new kind of nursing

When I was in nursing school, a mere six years ago, I couldn’t imagine nursing other than in a face-to-face environment. At the time, I knew there were telephone triage nurses, but I really had no concept of that type of nursing. But hey, nursing is nursing, right?

We all go through the nursing process each time we interact with a patient (even if we swore we would never again acknowledge the term “nursing process” after we passed the NCLEX—I know, I said it too). The nursing process is embedded in each and every registered nurse. I’m sure we could rattle off the steps of the nursing process in our sleep: assessment, diagnosis, planning, implementation and evaluation. So again, nursing is nursing, right? Right! But in my most recent job role, I have been introduced to a new kind of nursing—virtual nursing.

I spend each day at work interacting with patients I have never met, most of whom I probably never will, and I love it! Please don’t misunderstand; the reason I love interacting with patients in the way I do is not because I am not face-to-face with them but, as a proud Generation Xer/ Millennial, I use technology A LOT. I think being paid to e-mail and call patients is the greatest thing since the invention of the IV pump. After all, when I’m not at work, I spend upwards of 50 percent of my leisure time talking on the phone or e-mailing/texting my friends.

People are often surprised to hear that I am a nurse who spends all my time in an office sitting in front of a computer. Sometimes, it is even shocking to me. Back when I was in nursing school, I thought there were only three ways to ever have my own office: 1) become a nursing professor, 2) become a hospital administrator or, 3, leave nursing and work in corporate America.

Boy, was I wrong! I work in neither academia or nursing administration, but I spend all day calling, e-mailing and faxing patients. Each morning I walk into my office, look outside my huge window to see whether or not I can see the Hollywood sign that day (this, of course, dictated by the amount of smog in the air—got to love Los Angeles!), log on to my computer and begin typing my little heart out.

I go through the nursing process with each and every patient encounter; there’s nothing different about that. I triage patient e-mails and telephone calls, deciding who has the most urgent need and who should be contacted right away. I order medications, labs and radiology tests, using standing orders and a list of physician preferences. And I do it all online!

Although I sometimes miss the adrenaline rush of running to a crash Caesarean section or the excitement of a vaginal birth, there are aspects of virtual nursing I love dearly. I love chair dancing as I listen to a popular ringback tone, while waiting for the patient to answer her cell phone. I love reading e-mail responses from patients who thank me for ordering or refilling a prescription. I love receiving a call from the nurses’ station, because a patient has come in for her appointment and she wants to finally meet me. I enjoy establishing relationships with women I have never seen face-to-face!

When I get tired of staring at the computer screen and I need face-to-face interaction, I simply walk out of my office and down the hall. I have the best of both worlds. Now, if only someone would create a way for me to communicate with my patients via Facebook and text messaging, I’d be in nursing heaven!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

The night hello meant goodbye

It was a night I’ll never forget. It started off like any other night in Labor and Delivery; we were short-staffed and running around like chickens with our heads cut off. I was assigned to work in triage and, considering I love working in triage, didn’t mind the constant flow of incoming patients.

A late-preterm patient, with a sweet disposition, came in complaining of ruptured membranes. She wasn’t scared, wasn’t anxious, just slightly inconvenienced. I introduced myself and began to do all the things a triage nurse does when a new patient is admitted. I had her change into a gown, noted the fluid and attempted to place the fetal monitor and tocodynamometer (the ultrasound device used to record uterine contractions).

I tried for a few minutes to locate fetal heart tones and, when unsuccessful, put a request in to the physician on call to assist me. While waiting for the physician to arrive, I brought the ultrasound machine to the patient’s bedside and tended to other patients.

The on-call physician examined the patient and asked for the assistance of another physician. Any experienced Labor & Delivery nurse understands that, when a physician is using ultrasound to locate fetal heart tones and calls for a second opinion, it’s actually to confirm absence of heart tones. Stopping what I was doing, I walked to the patient’s bedside. The second physician confirmed that there were no heart tones. I called my charge nurse to let her know I would no longer be working in triage, because I wanted to take on the assignment of the patient with the fetal demise.

I began to admit the patient while she was in triage, and she called her family to let them know what was going on. She complained to me that she was leaking a lot. I pulled the sheet back and noticed bright red blood. Leaking small to moderate amounts of blood, which we call bloody show, is a normal sign of labor progression, but this was different. Within seconds, the patient had bled through the Chux pad, down her leg and onto the sheet. It was a little more bleeding than I was comfortable with, but I wasn’t highly concerned.

As I continued to get the woman ready for transfer to a private room, she began to bleed again. This time I was concerned and called the physician, who decided the patient would be taken to the operating room for a Caesarean section. There was no urgency to save the life of the fetus, but the life of the mother was now in question. She would hemorrhage if we didn’t move quickly. The surgery went off without a hitch. The physician confirmed placental abruption as the cause of the bleeding.

I carried the baby over to the warmer and began to wipe her off. She was beautiful! A perfectly formed, beautiful little angel. I wrapped her in a blanket and carried her to the recovery room. The circulating nurse remained in the operating room with the patient while the physicians closed the incision, and the family members came with me. We were not very busy in triage anymore and there were nurses on the unit with no patients, so I decided to take my time and give the best possible care to my patient and her family.

I began postmortem care by doing something I’d never done before to a deceased infant—I gave her a bath, preparing a basin just as I would for any other baby. I washed and dried each part of her body, then her hair. After placing a T-shirt and beanie on her, I let the family sit with her as she lay under the warmer. Later, the mother came into the recovery room to grieve with her family. (There were no other patients in the room, so I allowed the family to come in, without worrying about the one-at-a-time rule.)

As morning drew near and the night shift was ending, I transferred the patient from the recovery room to her room in Labor and Delivery. Once she was settled, I excused myself and walked into the restroom, because I didn’t want her to see me cry. After a few minutes, I was able to pull myself together.

The infant was the most beautiful baby I had ever seen. Although I had taken care of plenty of women with intrauterine fetal demises in the past, this one was different. I was emotionally invested in this family’s unfortunate circumstances. I had cared for the infant as if she were my own living, breathing child. I did not want to believe we all had to say goodbye before we ever said hello.

Walking back to the patient’s room, I told the mother goodbye. I will probably never see her again. She may or may not remember me. But the experience I shared with her will stick with me forever. I have no answers to why such a beautiful baby girl was gone before she ever breathed her first breath, or why this assignment affected me in such a severe manner.

What I do know is that, when I have my own children someday, I will cherish each cry, and each rise and fall of their small chests. Not every parent gets the opportunity to hear their baby scream or feel their baby’s breath on their face. Sometimes, saying hello means saying goodbye.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.