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Thinking Like a Nurse
Mary Holston
04/16/2010
Capital Hill Healthcare and Rehabilitation Center
Hours spent completing activity: 18
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Thinking Like a Nurse
As a young girl, I often sat in the window watching my aunt as she walked down the
street to the bus stop. She was neatly dressed in her white uniform, white shoes, white stockings
and her nursing hat. The neighbors would wave and compliment her on the neatness of her
uniform. Sometimes people would call and come by to ask her advice or opinion regarding an
illness. I can remember she spoke eloquently as she chose her words when educating the
neighbor. She always spoke in terms the neighbors understood and was respectful. I admired her
nonjudgmental attitude when speaking with the neighborhood alcoholic. As I sat admiring my
aunt, I knew someday I would become a professional nurse.
The years have passed and my aunt is now deceased. I am the nurse in the family with 22
years of nursing experience. Most of my experience was in a long term care facility for 14 years;
the most rewarding job of my career. I moved through the ranks from nursing assistant, licensed
practical nurse to registered nurse. I spent three years as night shift supervisor and realize I
needed some hospital experience. The remaining years of my career were five years critical care
experience and now four years of medical intensive care nursing experience. My career is the
best chose I ever made.
It’s a typical day at the nursing home, where I supervise licensed practical nurses and
nursing assistants. A few residents are sitting in their wheelchairs in the hallway and dayroom.
The nurses are passing medications and the nursing assistants are putting residents in bed and
helping with other activities of daily living. As the registered nurse supervisor, I get report from
the previous supervisor and pass it on to the practical nurse supervisor who is late. The
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supervisor reports an uneventful day without falls, no fighting among the residents or staff and
no hospital admissions.
Before starting my rounds, I check the staffing making sure the units have adequate
coverage and go count the narcotics along with the other supervisor. When making rounds I
speak with the residents, sometimes rolling them out in their wheelchairs to the designated
smoking areas or provide them snacks. I check with the nursing team for any needed supplies or
other essentials they may require. The other supervisor has made her rounds without problems or
complaints from the residents or team members.
Several hours pass and I am making rounds again on the first floor. The nurses there
report an uneventful shift at this time. The intercom system is announcing, Code Blue third floor
room 125, Code Blue third floor room 125, Code Blue third floor room 125 and I race to the
stairs. As I enter the room a crowd has developed, six nursing assistants standing around with
one nurse doing chest compressions sweating profusely, and the other nurse is performing
manual resuscitation with the mask over the resident nose and mouth. I ask the nurse what
happen as I remove the mask and connect the ambu bag to the tracheostomy tube and start
ventilating the resident. My critical thinking skills tell me the airway is compromised, because
there is no chest movement. The nurse says when she entered the room, the resident was
unresponsive and she was unable to obtain vital signs. She called out to the nursing assistant to
call the code and bring the crash cart and she proceeded to do chest compressions.
While the nurse was telling me what happen. I disconnected the ambu bag and pulled out
the inner cannula which had a mucous plug on the end. As I reach to get the emergency cannula
which is kept at the bedside, I asked a nursing assistant to relieve the nurse administering chest
compressions and she stated she wasn’t certified. Another nursing assistant stepped forward and
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relieved the nurse. I put the clean inner cannula in place and started mechanical ventilation. The
chest was now raising and falling. After giving the resident several breaths and reassessing the
resident he remained pulseless and with no spontaneous breaths. We continued cardiopulmonary
resuscitation until the ambulance arrived. The other nurse working the unit had already called the
ambulance, doctor, family member and started getting the transfer paper work in order. The
paramedics arrived and continued with cardiopulmonary resuscitation and transported the
resident to a local hospital. From start to finish this event lasted approximately 20 minutes.
Taking care of the resident is top priority in any setting. But in the long term care facility
the staff is the only family many of the residents can depend on. When the nursing assistants
stated they were not certified in CPR it upset me. We had failed our residents and this is not
acceptable. The residents are placed in our facilities to provide care for them, this includes
knowing basic CPR. The facility is the residents home and they should feel safe, protected and
provided the best quality care in their home.
I made the assumption that all the nursing assistants were certified, since they were
working the unit. The following morning I spoke with the nursing assistants. Some stated they
needed recertification and some were waiting for certification. I also spoke with the nurses on the
unit regarding CPR and remaining calm in a crisis. And one nurse stated it was here first time
participating in an emergency situation. During morning report I spoke with the nurse manager,
the administrator and the education coordinator about the incident. The nursing interventions
were performed for the resident. We needed intervention for the nursing team.
As the nursing supervisor I started randomly performing mock codes for the nursing staff
and all staff was required to participate. The education coordinator made sure all staff was
certified in CPR prior to taking a nursing assignment. The coordinator also informed staff when
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their certification was due and the facility provided training every three or four months. This
ensured no lapses in certification. And all nurses were required to attend one of the skill fairs
provided once a year.
The assumption I made regarding the residence airway was not valid. I inferred that once
the plugged inner cannula was removed, that spontaneous respiration would occur. But this did
not happen, manual ventilation was continued. And once the ambulance arrived, I made the
assumption they would connect the resident to a portable ventilator, but they continued with
manual ventilation. I inferred the family would request mechanical ventilation since the resident
was only 60 years old. But they requested to stop CPR and let the resident go naturally once he
arrived at the hospital.
We can call it professional values or nursing philosophy, but like physicians we have an
oath to provide responsible quality care to our clients. As nurses we are to be professional,
nonjudgmental, respectful, caring and sensitive to the client and family members. We should also
show compassion and patience as we provide quality care for the client. “Adherence to a code of
ethics is expected in any profession” (Kearney-Nunnery, 2012, p.8).
My clinical reasoning and self-reflective skills have been enhanced by learning everyone
is not in the same place in their nursing career. Nurses mature every day in their nursing roles.
Some nurses are better in emergency situations than others. We must always use our critical
thinking skills as we perform nursing duties. These skills develop and mature as we become
more experienced nurses. As nurses we should always be willing to help each other and be
respectful of one another. Nursing is a lifetime of learning experiences, and should be shared
with other nurses.
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Reference
Kearney-Nunnery, R. (2013). Advancing your career (5thed.). Philadelphia, PA: F. A. Davis.