1. Greene, Katelyn Joy BSN, RN, ON-C

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EACH SHIFT BEGINS with the usual hustle and bustle. We hurry to start report and get the day started. Nurses, therapists, and physicians gather at the desk, planning out the course of the day.

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I get ready to begin my 12-hour shift. I must keep each patient's best interests in mind as the day unfolds. I need to address vital signs, lung sounds, heart sounds, and other assessments. Incisions, drains, and wounds; the list goes on.


I float from room to room trying to solve problems. Prioritizing is critical. Who to see first? Who can wait? Someone needs discharge teaching. Someone else needs a pain assessment. At the end of the day, I feel proud to get it all done.


Valid requests

But then there are the minor situations that arise. Family members come up to the desk.


"My sister doesn't have a toothbrush." "My aunt doesn't have a water pitcher or a remote for her TV." "My uncle's hearing aid is missing." All of these issues are valid, yet none of them can be put on the list of top priorities. How can they, with medications that need to be given, treatments to be performed, and specimens to collect?


I can't tend to those issues right now. Another nurse needs help transferring a patient. How can I deal with a minor situation like a patient not having an extra pillow? But I answer them. "Yes. Yes. Ok." "I'll get to that." "We'll get her what she needs." "Let me write that down. I'll get right to it."


I have the best of intentions-I truly want to fulfill their requests, and usually do. Ninety-five percent of the time I do it promptly. I try to please patients and their families to the best of my ability. But what about the other 5% of the time when I can't?


I think of this 5% later, on the way home or before bed. "I forgot to get Ms. H her TV remote," I say to myself. "And Mr. D didn't get his water pitcher." After a moment of disappointment, I make a mental note to do better tomorrow.


New perspective

Then one day my grandmother was admitted to a nursing home. I didn't say anything when I noticed a few things wrong on the first visit. I didn't want to be known as a troublesome family member. But it became apparent that I'd have to advocate for her.


"My grandmother's wheelchair is too big for her," I said. "She needs to be on a restorative walking program; she was walking two days ago and now she's wheelchair bound." The list continued. There were no paper towels in the bathroom. How could the staff dry their hands properly? She hates fish, but it was on her dinner tray last night. I bought her a wheelchair cushion to make her more comfortable. Now it's gone. Where did it go? Can she please have her hair dyed a darker blonde like she used to wear it? Can she have graduated compression stockings? Why is her toothbrush not here? How could they be brushing her teeth?


I was transitioning into how it feels to be on the other side, and was starting to realize how nonminor these issues were. Yes, the nurses were tending to my grandmother's major medical issues. But the smaller problems were going unaddressed. I called the social worker. I called the ombudsman. I was turning into a nightmare of a family member, which was the last thing I wanted.


Had they replaced her cushion or kept her walking it would have made her stay so much better. If they'd listened to me when I told them no fish on her trays, she would have enjoyed her meals more. Yet, in their eyes, the nurses were doing their jobs.


"We'll do our best," I was told. To them, I was being picky. To me, I was being a granddaughter.


Not-so-small things

I took this lesson and applied it to my work. I integrate these issues into my day now. I get the water pitchers and fill them. How can a patient get adequate fluids without it? I listen to meal preferences. I help decipher medication changes. I now realize how much these things matter. My job is not only to look at the big picture, but also to see the finer details.


I listen to the families' requests and try to tend to them immediately. Before I saw the way that my grandmother's "smaller" needs were delayed, I didn't understand how these small things really made a big difference. After having had that experience, I'm learning to respond to these requests 100% of the time.