Memorable moments in nursing from the road less traveled

Kansas Nurse, Aug 2002 by Landis, Beth

The patient looked at me with mistrust and argued with my plan. Finally he agreed. He would let the nurses check his blood sugar once a day and then he could decide how much insulin he needed based on our agreed-upon guidelines. He would try it for one week. What made this plan so unusual was that he was a prisoner in a maximum-security men's prison and he did not routinely participate in making decisions regarding his life, his health, or his insulin. He was convinced we were out to get him and dosing him with the wrong medications. To participate in self-healthcare was a new concept.

For the past nine years, I have traversed the country, working as a locum tenens nurse practitioner. I have worked in family practice clinics, HMOs, Indian health-service, emergency departments, urgent care settings, extended care facilities, a state mental health hospital, university health-service, and a maximum security prison. I stay one to twelve weeks, with an average of five weeks per assignment. Nursing is certainly not boring and I don't get burned out because I can do anything for three months. After a break, I have fresh energy for clients who need a new perspective and seem to have worn out their welcome at their clinic.

I work for CompHealth out of Salt Lake City, Utah, and they take care of all the details for locating housing, travel arrangements, and assisting with licensure. I have 19 state licenses which means I research nurse practice act regulations when I enter each state.

I'm often reminded about a young student at a college health center who presented a few days before graduation. She had developed an allergic reaction to her engagement ring, which she had worn for four years. The diagnosis was obvious and since she had not tried any medication, hydrocortisone was an easy first choice. What bothered me most was why she developed a sudden allergy and what else might be going on in her life. I wondered how she really felt about her upcoming wedding. I tried to get her to talk about her feelings and return to the clinic; however she was lost in follow-up since it was so close to the end of school. I often think, where is she now and how is she doing? Was there a correlation between her sudden allergic onset and the impending wedding?

Then there was the frightened teenager who was brought to the clinic by her uncle. Her heart was pounding and her chest hurt. Through a translator, I learned she had been in the US for only a few weeks and was due to start high school in a strange land with a language she did not understand. She had a history of panic attacks and her anxiety level was quite high. One of the medical assistants offered to share her story and serve as a mentor since she had been in the exact situation a few years earlier. Through the nursing encounter, I learned about the unique challenges in meeting the needs of migrant workers and their families - and where many fruits and vegetables come from in the grocery store.

One memory that often surfaces was my time in a small Missouri town, during the middle of a dark and cloudy winter. As I dressed for work, I heard on the radio, "local schools are closed because so many children are sick." I thought, what a day this will be as the clinic had one other provider and myself to see the entire town. I was grateful that day for parents who were able to care for colds and stomach ailments in their children, and that the day did not turn into a nightmare.

As I travel, I frequently offer to do programs for nurses and certified nursing assistants at the hospitals and clinics where I work. One of my favorite talks is about sex and growing older. This topic turned out to be fairly intense for a young Navajo staff at a small rural clinic where I was working. However, it led to a much larger discussion about cultural sensitivity to sexuality, cultural attitudes towards sex education, and teenage pregnancy. The staff soon collaborated among themselves about ways to talk to their young people about family planning.

Another favorite memoir is the young girl who appeared at our family practice clinic in Oklahoma for help to quit smoking. We reviewed all the options and methods she had tried in the past. Finally we agreed on the use of an antidepressant medication as well as some selected complimentary techniques. She returned the next week and the week after that. Before long, she announced that she felt better than she had in years. Her coping strategies with her elderly parents and children changed. She no longer felt anxious. She no longer felt depressed and experienced success in smoking termination. Her headaches were gone. She concluded she had been mildly depressed and anxious for years and was so glad to feel that the cloud over her head had lifted.

Then there was the time the nurse warned me before I went into the exam room, "The two-year old is out of control and the mom doesn't know what to do....I think she needs help with parenting skills." The teenage mother was overwhelmed by her toddler and her pregnancy exhausted her. She didn't know how she would cope with two children. Fortunately, in many Indian Health clinics, a mental health worker is in the building full time and so it was easy to facilitate the referral. Weeks later, the social worker informed me the young mother had worked through many of her own childhood issues, changed her strategies with her two-year old, and positively anticipated the birth of her next child!