Don't you just love when people actually let you do your job?? I don't really mean to be critical, but it's just so refreshing when people understand not only YOUR role, but also THEIR role!
I had a near perfect ONE VOICE experience on Friday....just thought I'd share it.
I work in an outpatient treatment center that services primarily oncology and solid organ transplant patients. If you need outpatient chemo, you come to us.(Now, I also cover the peds Hem/Onc clinic and radation oncology, but they're not the focus of my story today.) If you need a PICC line placed and you're outpatient, you come to us. If you need IVIG, lab draws from your port or line, outpatient antibiotics...you come to us. In our treament center there tends to be a core group of nurses who like to take the pedi patients, the others...not so much because"kids are harder." Friday we had a little 2 1/2 year boy who came in for IV antibiotics. He is a liver/small bowel/pancreas transplant recipient that I've met on a couple of occasions. He is in the custody of his grandma and she takes really good care of him.
Since a majority of our patients have lines or ports, I didn't even think about his possibly needing an IV...I was prepared with the toys to keep him busy for his 2 hour infusion. His primary nurse (nurse #1) was a nurse who doesn't often take care of our peds kids. She started to put "little dude" into the crib while another nurse (nurse #2....see how I name them so cleverly? It's a gift.) came in. Nurse #2 generally does take care of our pedi kids. I assumed they were doing their "checking the wristband" duty, but quickly realized they were going to start an IV. Now...we all know that you sometimes have to tread lightly around staff you don't know quite as well, and since I didn't know nurse #1 my brain immediately went into the "Hey...hold on, I've got a better way to do this" mode. All of a sudden, "Tra la la la"....nurse #2 said, "Why don't we do one of those 'sitting on the lap' holds you were showing us?" (Immediate internal heavy sigh of relief...we've got ourselves a believer!!) Nurse #1, on the other hand, didn't have any idea what we were talking about but was willing to try. ANYTHING to make it easier was her motto. BEFORE I worked in the treatment center, I had done some inservicing with the treatment center staff about ONE VOICE. About this time last year, we were able to add a child life specialist to the treatment center; they've only been accustomed to someone bringing them toys in an emergency. It's been exciting to provide child life services to this area and define what that looks like. I've done a couple "quick inservices" about positioning and distraction for some of the staff and most of the staff have been very receptive to "trying something new."
At this point, I backed up the turnip truck and started where we should have started at the beginning, by asking G-ma what works with "little dude." She told us that he does really well sitting on her lap. Ding, ding, ding...we have a winner!!
From here on out, it was ONE VOICE heaven. Little dude sat on G-ma's lap, nurse #1 did the IV, nurse #2 assisted and I blew bubbles....the PERFECT scenario. G-ma knew exactly what her role was, she kept his other hand away. The nurses knew their job, to get the IV done and let child life do the distraction. Now...I've always had no problem producing hot air at a moments notice...talking is one of my greatest strengths (and weaknesses), so blowing bubbles is NOT a problem for me. (I can even do it with saliva. Oops...tmi)
Picture this: Little dude sitting side saddle on G-ma's lap, G-ma keeping little dude's hands away from the IV start, nurse #1 squatting down doing the IV, nurse #2 assisting, child life blowing bubbles, little dude popping bubbles and smiling. The only "oops" of this scenario was lack of EMLA. However, our transplant kids have such limited vein access, you'd literally have to slather them in EMLA...head to toe. Sadly for this little guy, he'd been poked enough in his short little life, that he didn't really fight a whole lot. He started to fuss...and then....the bubbles took him to his happy place. It was just a great situation...everything worked beautifully. Not only did this make it better for "little dude" and G-ma (who said the bubbles really made a difference...he usually resists), it also demonstrated the power of positioning, play, and not a lot of chatter going on. Nurse #1 and #2 got a dose, first hand, of creating a less threatening environment and how distraction can make a positive difference. Sometimes this is all it takes to get things started in the right direction....one positive encounter at a time....and I didn't even need to throw a shoe!
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