Need help with a hospital scene

[Jackie Bee]

Anyone here has any experience working in a hospital? I need to write a scene where a new, rather inexperienced nurse 'saves the day' by proposing a solution to a sudden crisis with some patient. The doctor is unavailable, so she makes a decision, and her actions save the patient. What kind of a problem and solution could that be? (I have zero knowledge in that field...)

 

[Biskit]

Have you considered also joining Absolute Write? They have a whole thread devoted towards these sorts of questions: Story Research: Experts and Interviewees Wanted

 

[Jackie Bee]

Have you considered also joining Absolute Write? They have a whole thread devoted towards these sorts of questions: Story Research: Experts and Interviewees Wanted

Looks good, I'll check it out! Thanks!

 

[zmunkz]

My wife is a pediatric ICU nurse, and she laments when the new nurses start because they often have no idea what they are doing. It is one of those fields where, despite so much education, the vast majority of the practical learning is on-the-job and from experience. This makes it a little difficult for your scenario, but not impossible.

Nurses aren't typically in the role of "Dr. House" where they are looking for weird medical ailments, they are more concerned with the immediate needs of keeping patients alive and well (at least in the ICU setting). They do a lot of the actual work on that front... it is nurses who run ECMO, for example... maybe this nurse of yours happens to have familiarity with something like that at the right moment?

Or else, maybe if the nurse noticed something, maybe in the patient's belongings or about their person, that would indicate a misdiagnosis (or a complicating factor nobody else had realized was there). Maybe some kind of medicine an unconscious patient was taking and couldn't report which this nurse realizes would cause complications with the current treatment plan? In this case they could be in the middle of some treatment, for some reason its going poorly, and this nurse puts it together with whatever they noticed before. Something like that? I'll try to remember to ask my wife tonight if she has any ideas.

 

[Jackie Bee]

Or else, maybe if the nurse noticed something, maybe in the patient's belongings or about their person, that would indicate a misdiagnosis (or a complicating factor nobody else had realized was there). Maybe some kind of medicine an unconscious patient was taking and couldn't report which this nurse realizes would cause complications with the current treatment plan? In this case they could be in the middle of some treatment, for some reason its going poorly, and this nurse puts it together with whatever they noticed before. Something like that? I'll try to remember to ask my wife tonight if she has any ideas.

It would help if you could ask your wife! Things you propose are good, it would be nice if she could give some specific suggestions - what kind of medicine could jeopardize what kind of treatment? What misdiagnosis could happen and how could she notice it? Maybe the nurse notices the patient is being given an overdose of some medicine by mistake? What kind of medicine? That kind of stuff, something I could use to make it look realistic.. thanks!

 

[RX-79G]

Nurses are good people to notice drug/medical history mismatches - like a patient receiving a drug they are allergic to. But that isn't likely to be all that dramatic a scene on its own.

It might be better to do something like the lowly nurse is told to put away the patient's things and comes across an epinephrine autoinjector for a bee sting alergy. Everyone else is handling a major auto accident and the nurse is alone to monitor the patient and decides to use epinephrine on their own.

Alternately, the nurse finds such a clue about why the patient may not react well to treatment given (like the alergy), decides to watch closely and when thing go very wrong, does an emergency tracheotomy when no one will come to help.

 

[Mirannan]

One possibility that comes to mind is that the nurse is assigned to deal with the patient's property, and happens to find a packet of warfarin pills (or the little book used in the UK for the patient to hand in during routine checks) just before the patient is given an anticoagulant - heparin maybe?

 

[DelActivisto]

Have you considered also joining Absolute Write? They have a whole thread devoted towards these sorts of questions: Story Research: Experts and Interviewees Wanted

Sure - and get banned by a rabid admin with a thing for getting rid of "trolls," otherwise known as "people who disagree with me or my ilk." Seriously, stay away from that forum - it is toxic, which is sad, because it actually does have some good information on it.

 

[hopewrites]

Latex allergies are rare, but used to be problematic when it was everywhere in the exam room.

I once road in an ambulance with paramedics who didn't know if their IV equipment was latex free. (It was. Good thing too. No one wants to get hives in an injection site.)

 

[Theophania Elliott]

If she is a new, inexperienced nurse, it seems more likely that what she notices will be something like:

• My gran had that and...
• The lecturer mentioned in passing...

Stuff that's quite unusual, so other staff might not spot the significance immediately, but this particular nurse has a reason to know it.

It would help a lot if you could give some details of what the situation is, and what you're trying to achieve with the scene. Is it the patient who's important, or the nurse? Is this just a generic MC-saves-the-day scene, or does what happens in this scene have implications later on? Why is the patient in hospital - were they admitted as an emergency, or as an elective? Is it a little cottage hospital, a district general, or a big teaching hospital? Also, what country are you in? People get ill and injured in pretty much the same way all over the world, but hospital procedures differ between countries - and so do the drugs used, or even the names for the same drugs.

There is also the aspect of, do you want everyone else to look incompetent, uncaring, or careless? If the other staff - doctors, nurses, pharmacist - have all missed this, why did they miss it? Yes, people make mistakes - that's why they call it human error - but when you make a scene out of it in a book, you're making your heroine look good by making everyone else look bad.

Also, why is the doctor unavailable? The bigger the hospital, the less likely that a doctor is going to be unavailable. If it's a drug related problem, the ward staff will be able to contact a pharmacist - even if there isn't a 24-hour residency, the emergency duty pharmacist will be contactable by phone.

To me, this leans towards there being a problem that this nurse knows how to solve because of some kind of personal knowledge - that steps around all the business of who's available for advice, and what professional experience people have.

For instance, try this:

The patient has an infection. They've been trying all kinds of antibiotics and stuff, and nothing's working. The patient is sinking, and it's looking bad. Samples have been sent off for cultures, but results aren't back yet. Suddenly, the nurse remembers that she'd been talking to the patient a few days ago about his trip to Canada, and how he was visiting family and they had a lake house, and it was really nice. She'd said that she, too, had relatives in Canada with a lake house (they're popular in some areas of Canada), and one of her cousins had picked up a really bad infection while they were out there, and nearly died....

The nurse remembers the name of the infection and tells the doctor. The doctor looks it up, realises that it matches the patient's symptoms, and changes the antibiotics (to an antifungal, I think, from memory), and the patient starts improving.

Pats on the back for the nurse, because it's a rare infection that wouldn't have been thought of until the cultures came back, and by then the patient might have been dead...

This is a real case that was written up in a medical journal - in the case report, the second patient's infection was treated quickly because the author of the report had seen the first patient and remembered the symptoms.

If that sounds like something you could work with, I could see if I can find the case report again.

I'm a pharmacist - I've worked in hospitals for 16 years. I used to work on the wards; now I provide clinical advice to the people (doctors, nurses, pharmacists, etc) who work at the sharp end. The coffee quotient is better, and I get to deal with the weird stuff that other people can't.

If the rare infection doesn't float your boat, I might be able to think of something else, if you can give some details about what sort of thing you're trying to accomplish etc.

 

[kythe]

I'm an LPN with 9 years of experience in long-term care settings such as nursing homes and group homes. I have no hospital experience beyond clinicals.

In my experience, new nurses are generally watched and guided more closely at first because it can be very hard to adjust to a work environment. One thing that has been said is that although nurses fresh out of school have poorer practical and time management skills, they do tend to have a greater knowledge and understanding of new medications and procedures.

Granted, long-term care environments aren't known for cutting edge technology the way hospitals would be. I've had times where I'm trying to remember back almost 10 years for how a certain procedure is done, but a new grad nurse may have just seen it last month and be able to quickly share fresh knowledge.