Brenda was shaking and upset when she arrived at the surgical holding area. When the transporter parked the gurney, I could see Brenda was near tears.
As a nurse anesthetist, I see a lot of patients who are overcome with anxiety before surgery. This being a Saturday, it is common that patients are even more anxiety-filled because weekend surgeries are usually not planned in advance. The patient has come into the hospital and been told that surgery is needed and there is not a lot of time to prepare emotionally.
But as it turned out, Brenda’s primary problem as she came into the holding area wasn’t anxiety. She was in extreme pain from her IV site. She was holding her right arm out straight and told me that on a scale of 0-10 with 10 being the worst possible pain, her arm was at a 10. I asked her when was the last time that the IV site was used for medications or IV fluid and if it hurt at that time. She told me that the IV site was painful in the morning and she reported it to her nurse.
The nurse apparently “flushed” the IV to determine if it was still working and to see if there was swelling. When there wasn’t any increased swelling with the IV flush, the nurse told Brenda the IV was fine. This is a common step when there is a question about an IV. We take a syringe with a small amount of fluid and flush the IV. If it is difficult to flush, or if the skin at the site starts to swell, we know that the IV is not working properly. However, what the nurse did not consider when she decided to infuse Brenda’s IV with medication that morning was that the most important evidence that an IV is not working is a patient who is in pain.
Brenda, upset about having to have surgery was not able to effectively advocate for herself. And so, the nurse infused a very abrasive medication into an IV that was not properly working. Now Brenda was in pain, and her arm was swollen. I apologized to Brenda, removed her IV and wrapped her arm in a warm blanket to sooth the irritation. I then started a new IV site on her other arm so that we could proceed with the surgery.
This experience with Brenda made me think about how often patient’s concerns are not really listened to and taken seriously. As healthcare providers we need to know that the best evidence starts with the patient. Even though the nurse was right to say that from her perspective the IV was working-that did not change the fact that her patient was in pain. The nurse forgot that the most important perspective in this situation was Brenda’s.
Having a painful IV may not seem like a major problem. Indeed, it was not treated as a serious issue by this nurse. But complications from IVs can be quite serious and may even lead to extensive tissue damage requiring surgery to repair.
If you are in this situation where you are telling a nurse about a problem and you do not feel heard, ask to speak to another nurse. You may be inclined to feel that you do not want to be a “problem patient” so you let the issue drop. But that is not the best approach and real harm can be the result. You can try this script: “I do not want to seem that I am arguing with you and I respect your expertise. But I really feel that this is a problem and I would like to speak with another nurse, perhaps the nurse in charge to get her opinion.” You want to keep the exchange friendly and respectful, but you also need to know that your concerns are being attended to appropriately.
We each have to be active participants in our healthcare. Although it is important to have trust in the professionals caring for you, you need to remember that YOU are the most important element in the healthcare equation. Be sure that your concerns are taken seriously.
