Guerrilla Nursing

By Pamela Bennett

Guerrilla tactics may be the bedside nurse's only resource in the daily struggle to survive and provide optimal patient care. New nurses will find advice about choosing a hospital, and preserving sanity while working in a hospital. Both new and experienced nurses will benefit from the analysis of hospital interactions with doctors, patients, and other nurses. The interactions are presented in a humorous light, with techniques for optimizing future events. Nurses will meet characters such as Dr. Dim, Dr. Olympus, Nurse Flubbie, and Mr. Spicious.

• Language: English
• Publisher: Pamela Bennett
• Release date: Dec 17, 2012
• ISBN: 9780988732414

Pamela Bennett

Pamela Bennett grew up in Durham, North Carolina, and graduated from Crofts College and the University of North Carolina at Chapel Hill. She owned and operated Black Sheep Baskets in Dallas, Texas, which featured her jams. She now lives in Provo, Utah.

Book preview

Foreword (to Victory)

First, I apologize if you are looking for a veterinary manual. The publisher thought I said gorilla, not guerrilla—hence the cover art. This is a book for humans that work in human hospitals. So what is guerrilla nursing and do you want to be a guerrilla nurse?

Guerrilla warfare is a collection of tactics and strategy employed by a smaller, less powerful contingent against a larger, more organized and powerful force. Nurses are the weaker force in the battleground that is the hospital. Nurses constantly struggle to provide optimal care for their patients despite limited power and resources. A direct confrontation will rarely successfully overcome the obstacles encountered. Instead, nurses must usually resort to subtle, indirect tactics based on their superior knowledge of the opponent. This opponent may be a bureaucrat, a doctor, a fellow nurse, or a patient. The guerrilla nurse understands the nature of these inter-relationships and how to optimize conditions for the nurse.

This book was written from the viewpoint of a nurse, primarily for nurses, but the techniques are applicable to any health care worker that interacts with doctors and patients. There will be no information on actual nursing or patient care. You spent years of your life learning how to give respiratory treatments, do X-Rays, pack wounds, start IVs, give a therapeutic enema, etc. I wouldn’t insult you or your teachers by presuming to give such instructions. This manual is of a practical nature, with tips and tricks for dealing with the labyrinth of hospital life. If you are one of the rare, happy people that don’t work with patients, doctors, hospital bureaucrats, or nurses, this book will probably be gratuitous. If, however, you are slogging down in the trenches with the rest of us, this book may save your sanity, if not your professional life. More than thirty years of on-the-job research went into developing this manual. I hope you find it both of practical use and amusing. My philosophy is simple: if it doesn’t kill you, it should make you laugh.

Handmaiden/Servant to the Gods

Do you remember the joy of graduation day, the thrill of passing the Nursing Boards, the exhilarating optimism when hired for your first real nursing job? Soon the debts and money worries, the cheap clothes, the public transportation nightmares suffered during nursing school, would be vague memories from a previous life. You would now have the privilege to function as a bedside nurse in a hospital. You would satisfy all your nurturing instincts; you would experience complete gratification as you provided compassionate care to the sick and dying.

That is the dream. The reality can make you jaded and cynical, if you don’t take proper precautions. This applies to both new nurses and seasoned veterans. Current nursing practice is a reflection of past nursing history. There can be no understanding of the Present without examination of the Past. (The history phobic need not despair, for this account is drastically over-simplified, and massively abridged.[1])

Historically, during peace time, most nursing care was delivered by family members. During wartime, nursing care was mostly delivered either by nuns, or camp followers. The nuns provided relief to the suffering and the dying through hands-on care. They washed the gangrene wounds, held the hand of the dying man, and prayed with the surviving family. The camp followers did the same (except maybe not the praying), and also improved the morale of the unwounded troops through direct hands-on care.

The nuns had taken a vow of poverty, so any offer of recompense would not only have been refused, but insulting. What? You want to pay me for this work? I couldn’t accept that! What would Jesus do?

The camp followers had a different attitude about the need for proper recompense, but were outnumbered by the nuns; the nuns’ philosophy prevailed. (Even today, some nurses experience a faint feeling of guilt when demanding a decent wage.)

When medicine became an established profession (not just the local barber who also did surgeries on the side), it became necessary to have trained people that could carry out the prescribed plan of care. The problem was that the number of men needing nursing, exceeded the number of women willing to become nuns, and forego childbearing (and sex). Consequently, the profession of nursing was born. (Interestingly, many nursing schools were originally taught by different religious Orders.)

Over time, as doctors transformed from barbers to Greek gods, they developed unlimited legal medical power. Their word is mighty and Law to all others. This is both blessing and curse. For like the Greek gods, doctors have mortal ambitions, drives, and flaws. Despite extensive education, doctors are not omniscient. Sometimes, doctors make mistakes.

Your role as handmaiden/servant to these gods is to carry out orders, minimize pesky reminders of their true mortality, and assist their efforts to achieve greatness. You will diplomatically provide information and assistance, and regularly exercise your clairvoyant skill. A good nurse should know what the doctor is likely to do and need, in any given situation, and have it ready in advance. If the doctor is about to commit an inadvisable act (such as order a medication that is incompatible with the patient’s current medications), the nurse should gently remind the doctor of unconsidered factors, so that the doctor can reconsider the course of action.

Example:

John Blue is a thirty year old with broken ribs from a motor vehicle accident. After moving out of bed, he began having difficulty breathing. Nurse Houdini answered John’s call light and found John sitting in a chair, working hard to breathe, but still with good color. Nurse Houdini immediately called for assistance, and paged Dr. Zeus (John’s physician). Nurse Houdini knows it is possible John has a pneumothorax, or a pulmonary embolus, and will need more advanced, immediate care. Nurse Houdini will: monitor vital signs and oxygen saturation; provide oxygen, as needed; alert X-Ray; gather supplies (transilluminator, chest tubes, suction set-up, etc.). Many of these supplies and tasks can be performed while awaiting the physician. Once Dr. Zeus arrives, Nurse Houdini is prepared for almost anything.

Dr. Zeus: Nurse Houdini, I’d like to check with the transillluminator while we’re waiting for X-ray. How have his vital signs been?

Nurse Houdini: I’ve got it right here, Dr. Zeus. We put him on a monitor a few minutes ago, if you would like to check the numbers. His sats are a little low—high 80’s. A gurney is coming to take him to X-ray. I started him on cannula oxygen at two L/m, but would you like for him to have more?

Dr. Zeus: Two seems fine for now, but if his sats dip lower into the 80’s, go up to three L/m.

Both the transilluminator and X-ray confirm a pneumothorax. Nurse Houdini ably assists Dr. Zeus. Nurse Houdini was well prepared with all needed supplies, including suction set-up for the chest tube. After the procedure, John Blue is resting, well sedated, breathing comfortably.

Dr. Zeus: Well, that went well. I’d like to start John on Claforan and Vicodin for a few days, while the chest tube is in.

Nurse Houdini: Oh, John is allergic to codeine, Dr. Zeus. Is there something else you could order for pain?

Dr. Zeus: Sure. Let me know if there are any more problems.

Nurses can enhance a doctor’s performance and a patient’s outcome, by knowing the patient’s history and proper prior planning. A good nurse is none-the-less important for being a servant. Good Help is hard to find, but we all need it.

Never underestimate the importance of suiting the job to your personality.

Choosing Your Specialty and Your Hospital: It’s Not Just A Job, It’s An Adventure.

If you are just beginning a nursing career, or are considering a change, there are many choices in your future: where to live; where to work; what specialty to choose. Sometimes your choices may be limited by circumstances beyond your control: nurse supply/demand, for example. Obviously you will have the advantage when fewer nurses are available. Geography is also a determining factor: rural areas have limited choices. Don’t despair if luck and conditions are against you; luck and conditions can change. Determine your ultimate nursing goal, and work toward it.

Choosing a specialty is like choosing a college major. You may not know what you would like to do at first, and the sheer volume of choices is daunting. Relax. You aren’t bound for life to your first area of practice. Nurses change their specialty, just like students change their major—often several times in their respective careers.

Nursing instructors are adamant