Yes, I do need a license to do my job....

After a series of tough calls last night at work, I am needing to vent. So bear with me, forgive my candor, and maybe an occasional curse word. This is partly just me trying to reinforce to MYSELF why I do this particular type of work, and partly to verbalize in print what I can't say to a disrespectful parent on the phone.

I am asked on a fairly regular basis by either parents who call me, or a few family or acquaintances, whether or not I need an actual license to do my job, why I don't get a "real" nursing career, or if my job is actually hard. And I am left always feeling a little offended, somewhat saddened at the idea that people would actually ask me this, and pissed off. After all I don't hear other people who have other careers such as I don't know plumbers, office manager's, hair stylists etc., get asked why they don't get a real job or do they need talent to do it. So yeah these questions rub me the wrong way and I am quite sensitive to the questions after 5 years of pediatric nursing. So let me clear up a few things....

• Most nurses in the any other field have the luxury of being able to SEE their patient, SMELL, and TOUCH their patient which allows them to make a thorough assessment and adhere to a plan of care accordingly. I however am not able to use these vital senses, I can only go by what I am told and what I hear. And in many cases it is questionable whether the source over the phone is reliable....throw in a screaming baby, a language barrier, the car radio, or a party in the background and that is what I have to work around. It may seem simple if a parent calls in for their infant who is having "the flu, a fever, and is lethargic" and they just want an appt. And if I didn't ask an other questions, they would probably be given one. But when I assess further, what they mean by "flu" is nasal congestion, and the "fever" is 98.8, and by "lethargic" the baby is needy but playful and active. Advice is really appropriate for this situation.

• Yes in order to work as an advice, or triage nurse as I prefer, it is required for us all to have an active California nursing license. And just like all other nurses I am required to have at least 30 hours of continuing education credits every other year to keep me "in the loop." In addition to these credits, at my call center I also attend regular courses with Kaiser physicians to discuss topics ranging from how to treat acute otitis media(ear infection), triaging ALOC (altered level of consciousness), to current research behind the pathology of migraine headaches, and the newest studies related to URI's/Cold/Influenza. This is just to name a few, I have these discussions monthly at least.

• My computer doesn't tell me what to do. I have generalized guidelines that lead to the most likely appropriate outcome for that particular symptom such as an appt, a message to MD, advice, paging a specialty MD, etc. And this is assuming that the parent is calling for just ONE symptom, usually there are multiple though.

• I am a pediatric advice nurse. I usually only take pediatric calls unless my queue is slow and in that case I will also get adult medicine and OBGYN calls. But the opposite is not the case, OB and MED nurses do not take PED calls.

• In addition to giving advice to parents about how to take care of their child who has a runny nose, a fever, is vomiting, has a sprained ankle,or hit their head, among many other symptoms, my role is to also determine the acuity of a situation and decide if it is safe and appropriate to wait for an appt, send them to the ED or call 911. Now to some, these options should seem obvious and more often than not it is...but not to some parents who call Kaiser. A parent who only wants an APPT for their 9 month only who's lips turn blue when they cough and is actively wheezing and retracting does not want me to tell them go to the ED or call 911. They want THEIR pediatrician to see their child RIGHT NOW at 9 at night, then they question my intelligence and tell me that I must not be a mother or I must not care about her child because I want her to wait in an ED waiting room for 5 hours, which wouldn't happen in this situation anyway. So after consulting also with an ED doc who obviously agrees with me, I STILL have to argue with a mother who doesn't understand why I can't make an appt for her. These calls typically occur a few times a day.
  

• I take calls about children who may be physically or sexually abused, I have had teens threatening suicide, alcohol poisoning, and the very common teen pregnancy. And again I will reiterate, my computer does not tell me what to do in these cases. Our computer protocols have guidelines to use as an assistance given a particular scenario but again, I have what is called Nursing Judgement, and sometimes that is all I have to go by. These calls are very lengthy, involve a tremendous amount of assessment, patience, support to the caller.

• There are advice nurses who quite literally, SUCK, at this job. I work with a few, I have spoken to some myself, and I have been in a position to fix some of their mistakes. And these are the nurses that give me, and Kaiser for that matter, a bad name. Those are the ones that say "well my computer tells me to...", or "sure you can alternate Tylenol and Motrin for TEETHING fussiness." I am not one of those nurses, I listen, I sympathize, I am always cautious, I don't say "you must be a first time mom." That's not me. I'm not perfect by any means, I am always trying to improve my skills, keep informed and knowledgeable, but I believe I am very good at what I do. Or at least I will keep telling myself that while a parent is yelling at me that I must not be a mother and I must not have a caring bone in my body to DENY her an appt. Yup that is my goal ...to refuse care for my patient, to make them wait in and ED waiting room, to send THEIR doctor out of town.

• I say this all the time on the phone, I am a first time mom myself. I am a mom first and a nurse followed closely behind. My instincts and emotions as a mother always take precedence. I make mistakes as a mom in general, after all I have never done this before. And by mistakes I mean when T is sick I am terribly worried, never sleep, and always wondering if I could do something different. That is what we do as mom's.

I wish that I could say these things to parents who continue to berate me, say hurtful things, and minimize my role in actually helping them with their sick child It's frustrating to say the least. But then I get that some amazing parents on the phone who are just tremendously appreciative that we are available to guide their family through a difficult situation, to say they will absolutely try my advice, and say Thank You.

Finally these are the issues come up daily and that literally, Irk me, Worry me, Frighten me...

• Buy a thermometer. The excuse of "the back of my hand is very reliable, I can tell up to the tenth of a degree what my child's temperature is" is getting old. I wish I, or any seasoned physician had that talent. Don't get me wrong, you can feel that your child has a fever, I know that. But the actual measurement is important like an other vital, O2 sat, respiratory rate, blood pressure, etc.

• Lethargic. This term should not be used loosely. Lethargic does not mean my child is playing a little less, took a longer nap, is needy - that is listless. Lethargic is limp, floppy, slow to respond to voice or touch, toxic looking. There's a big difference.

• There isn't a medical provider on this planet that works 24/7 and is available at the whim of their patients. Kaiser is not the only hospital who's clinic's close at various time of the day and week. So if a parent calls at 8pm on Friday wanting an appt now for their child who has a runny nose for 2 weeks, then we'll see them on Monday. This isn't lack of patient care, this is common sense.

• No, you can not give a 3 week old newborn cold medicine....seriously this was an actual question recently. No need to elaborate.

• OTC cold medication really doesn't work. It makes kids drowsy and sleepy, sure. But that's it. In study and research these medications do nothing to alter the course of the illness.

• The dropper or cup that comes with the bottle is ONLY for that medication and nothing else. They are never interchangeable, never. Do not guess. There is a reason the box says call a doctor for dosage under age 2, and doses according to weight and age.

• A fever is not harmful, it is truly helpful. It does not cause seizures or brain damage, if that were the case then every child on this planet will have a seizure multiple times in their childhood. Sepsis is suspected if the fever goes above 105, but all children will have a fever up to 104 a few times.

• Alternating Motrin and Tylenol for a toddler with teething pain is absurd. Babies are fussy, irritable, wakeful at night, and don't eat a lot for a few days during this process. These pain relievers have little effect. And alternating both... that poor child's liver.

• If your daughter's arm is literally snapped in two and deformed, do you really think it is logical to take the time to call your assistant first to tell her to call me first to see if you should go to the ED....this really happened.

• To the 14 year old girl who is having sex with multiple partners, but finds it embarrassing to say the words sex, intercourse, vagina or penis.....good luck, you probably will get pregnant soon, yes it can happen to you -if he pulls out -if you missed one pill -if you only did it once. My advice on protection, abstinence, and STD's typically falls on deaf ears. These calls sadden me. I always want to do more but they usually just want yet another RX for the morning after pill.

• I have no way of knowing how the judge at your divorce hearing will interpret your children's medical records. It's all there in writing, I can't change or alter it.

• The white discharge that comes out of an adolescents pimple is NOT a parasite or a worm, and no your pediatrician will not want you to save it in a baggy for further testing......I'm laughing right now, this really was a concerned parent.

• Nurse's have no way of knowing what EVERY ingredient in EVERY food or skin product or medication is, and we do not know the name of EVERY medication, what it treats, and what the side effects are. If you ask me why I don't know, it is because I am not supposed to know, I am not a doctor or a pharmacist. If you work in the medical field, it does not predispose us to be all knowing of all things medical. That is humanly impossible. Unless you are Dr. House of course.

• Never stop giving your child fluids because you are scared they are going to throw up on you again. There is an effective process to offer fluids, but don't deny fluids out of fear. Hello, dehydration

These are a few common issues. I'm through venting. I wish my difficult or disrespectful patients could read this as I know to all of you, my amazing family and friends, really you are reading this and saying Kristen stop whining! I know I'll stop, it could always be worse. And as I have said before, I know that I am blessed to work where I do for the hours that I have. I am thankful for all of the wonderful parents and patients that I have had the pleasure of helping and teaching and just conversing with...In general I enjoy my work immensely and take pride in it. I have come across and assisted families who have experienced the worst of the worst when it comes to illness and I have become a better nurse because of what all of these experiences good or bad have taught me. It still felt good to get this off my chest.