Collaborate This

So, I’ve never really preferred to make decisions by myself….which is one of the many reasons I became a nurse instead of a doctor; doctors ultimately make the decisions.  Don’t get me wrong - nurses make plenty of decisions! That’s not what I am saying. I’ve told a doctor what I think should be done and have even questioned a doctor’s order to advocate for a patient. But ultimately, the doctor decides the diagnosis, treatment plan, and what medications to give. And I am completely in favor of that.

But as a nurse in Haiti, I am acting far outside my “scope of practice” as a licensed RN and find myself more often acting as a nurse practitioner/doctor - diagnosing and prescribing.  I’m not working under any sort of license here, and don’t think I have to worry about my license to practice nursing in the States being affected at all. (Speaking of, just paid $89 to have that thing renewed, so I think I am good to go).  But more unsettling than the state of my license is the blunt reality that my level of nursing education, aside from a basic Pharmacology class, did not prepare me for having to prescribe meds and create medical treatment plans. Yet it’s what I am doing: Looking up antibiotic preferences, doses and durations while a man with a gashed, infected hand sits next to me; Calculating an appropriate drip rate for rehydration while attempting to start an IV in an infant; Researching abnormal lab results and unfamiliar diseases in order to decide how to proceed; Figuring out iron doses for anemia; Creating a re-feeding schedule for a malnourished child while taking into consideration micronutrient and electrolyte status; Examining skin conditions and deciding what cream will treat it; Using a scalpel to slice open and drain an abscess; Listening to lung sounds and trying to decide if it’s a common cough or if I should test for tuberculosis; Comprehending as someone explains their symptoms in Creole and deciding what medication will help them...to name a few.

 

These things, which are part of my everyday happenings, have stretched, challenged, terrified and exhilarated me. And a foundational thing that has kept me from fearfully dreading every nursing/medical decision is this: collaboration. As I become more familiar and comfortable in this role, I am more confident and bold to make decisions. Even so, it is so reassuring to know that I never have to make a decision independently. There are other people on staff here that have lived here longer, seen more, experienced more and are full of knowledge. If I am uncertain about something, I can go to my supervising nurse, Erin, and either have her advise me about what would be best, or get her affirmation that my plan of action is appropriate. On gate days, I work closely with our social worker, Carla, who often translates for me, helps me talk through situations, and shares suggestions. There are also other medical personnel we have connections with - nurses, doctors, pharmacists, dermatologists, etc. - who are just an e-mail away for a medical consult.

Just over a week ago, an American doctor and two residents were at a nearby hospital volunteering and they asked about coming out to Children of the Promise for an afternoon to help out.  Honestly, I was not really looking forward to them coming initially, which surprised me knowing how much I strive off of collaboration and reassurance. I realized that I was nervous they would assess how capable I was or judge medical decisions I had made. It was ridiculous and I knew that, but I had no idea how the day was going to go with them. When they arrived, after a brief tour, they were ready to jump in and see kids I had questions about or community members that we had called to come in.  My fears quickly vanished as I worked alongside these doctors...they were so smart!!  Questions that I would have had to spend time researching were quickly addressed. It was exhilarating to watch them work together, discussing possibilities, and even being able to give my own input and participate in making treatment plans with them. The morning flew and I was just so excited about all the things we accomplished. I nearly considered asking (begging) them to stay forever. Instead of being made to feel incapable, like I had feared, I instead was inspired by how much I was able to learn from them. I was excited to discuss medical questions with them. I was relieved to figure out how to best address some of the kiddos’ medical needs. I was affirmed.  

*The pharmacy where I spend most of my hours each day. The bins are full of medical supplies and medications.