Author Archives: Sonali Dhir

The epidemic of Overuse

Insanity is trying the same thing over and over again and expecting a different outcome.

The father and son duo who I  have seen three times since Christmas break have returned again.  The father is scowling because last time I refused to an order an antibiotic for his son’s allergies.  Of course the first visit I had relented  because the office was busy and the father practically demanded one. “ There are some fragile older relatives in the house. What I am kinda saying is we need that antibiotic.”

Flash forward a few months later they returned to see me again. The office was not as busy and dad was scowling about his son missing school yet again. The teenager had forgotten to take his allergy  medication. This time I educated them about overuse of antibiotics.  His father admits his mother has bad allergies. I recommended the teen take his allergy medication regularly and stay hydrated. The father is disgruntled I did not order an antibiotic. He mutters something about the antibiotic not lasting long enough last time.

Two days ago they returned after a few weeks gap. Now teen has a wet cough. He has been taking zyrtec  and allegra for his allergies. Teen reports green mucous and worsening over the past few days. Since he has a history of childhood asthma I relent this time to order the antibiotic. The father’s behavior is still very hostile and he scowls throughout the exam  declining the strep and flu testing.

Of course  I educate on staying hydrated and continuing his allergy regimen. The father asks if his son can play lacrosse. I state that as along as he has no fever and he is breathing fine, he can continue activity as tolerated.

The risk of severe diarrhea resulting in the diagnosis of Clostridioides difficile otherwise know as C. Diff plagues and kills many people across the nation each year. Recently the overuse of antibiotics have led to the discovery of a very resistant fungal infection cause by Candida auris. Medical teams and researchers are finding it difficult to manage the treatment as each regimen fails. A man suffered for ninety days in a New York hospital before succumbing to Candida auris. The unfortunate truth is that suffering could have been prevented had he not become resistant to typical regimens prescribed for his ailments.

I sigh with relief as they leave the clinic sometime later. All I can say sometimes you loose some and sometimes we win. The overuse of antibiotics and pain medications to mask symptoms is a common practice that the patients end up paying the price for sooner or later. As  new provider I sometimes find it challenging to educate my patients and their family members regarding the overuse of antibiotics. I attended a conference in New York a few weeks ago regarding gastrointestinal disorders. The common factor reported as the cause was overuse of antibiotics. I may not convince every patient I treat, but I shall make a greater effort to educate them about the  possible long term effects about using antibiotics prematurely.

We all need to make a conscious effort to promote probiotic use with antibiotics  and perhaps as a routine measure to prevent severe gastrointestinal side effects. The general public still believes the antibiotic is the cure of any ailment they present with. There needs to be more awareness and education in primary care settings , urgent cares and clinics.

sonaliSonali Dhir is a new nurse practitioner. She loves to travel and spend time with her family. She lives in New Jersey

The Kind of Nurse I am

“What kind of nurse are you?”

I was asked this by the errant wife of a patient I was caring for on a step down cardiac unit last year. The patient had warned me about her personality prior to her arrival to visit him. She was angry the doctor had decided to discharge him with a low grade temperature.

Honestly it was the tone of her voice that took me by astonishment than anything else. I shortly turned tearful as I could not reach the hospitalist in charge of his care. My manager was off and even if she was around I doubt I would get much support from her.

I had resigned, giving my almost three weeks notice a few days before. I was about to start my first nurse practitioner position. I should not have felt so desolate having endured many stressful and blissful moments in the seven years of being a nurse thus far. However the woman’s comments pierced something. It made me feel like a failure despite how many people I have helped before them.

If I ever met them again I know what my answer would be now nearly a year later.  I am a nurse that gives it her all. I am one to wear my heart on my sleeve. I am protective over my patients as if they are family members. I have spent sleepless nights wondering if my patients would survive the night, Would they still be around the next morning when I returned for my next shift?

So yes I may not always have every answer or be on time for everything you need.  However overall I will advocate for you and provide the best care possible in the time I have you under my care.

Many patients appreciate the care myself and other have provided. Unfortunately some forget we are humans too. We may not be superhuman, but as nurses we try our best to be your superheros without a cape.

Sonali Dhir is a new nurse practitioner. She enjoys traveling and spending time with her family and close friends. She has been a nurse for almost eight years and has spent almost a year working in retail clinic as a nurse practitioner.Besides caring for others, she is an avid reader, always looking for new knowledge.

The Second Victim

In May of 2018, I received some tragic news from a coworker of mine that still works on my old unit. Our coworker Mary Jane was found dead. Mary Jane was a second career nurse that struggled to keep up her morale at times working in our busy step down unit. We all had our moments of self-doubt and stress from working with complex patients and their families.

The news was horrifying for several reasons. Primarily because Mary Jane’s situation is not the first time a healthcare provider has taken their life due to personal and professional stressors. Level of experience does not always deter medical professionals from taking such a drastic step.

Mary Jane had a family that loved her and had a whole different career for over ten years before she became a full time nurse. Every day we work hard to ensure quality of care for our patients. Family members and administration question why certain patients improve and others decline. We have monitors and patient care  quality measures to ensure better patient results.

However, when is the last time a hospital, clinic system or any other healthcare facility approached a method to ensure quality of self-care for healthcare providers? The family and the patients are the first victims of an event. In recent times the horrifying truth has come to light, healthcare providers are more deeply affected by patient outcomes than previously understood.

Caregiver role strain does not apply to family members and loved ones only. It affects anyone who may have cared for a patient, or formed a strong bond with family members. Mary Jane worked relentlessly for months on that unit. She formed great friendships and bonded with patients and their families. She along with others missed lunch breaks and still  felt what she did for the day was not enough. At the end of each day, she would return home weary eyed , hungry and disheartened. There was no reprieve from her daily struggles.As time went on she began to avoid conversing with coworkers. She appeared to be dragging herself through her shifts. She took a break and tried to rejuvenate herself. Mary Jane was determined to keep working and becoming a better nurse. She made personal goals and wanted to go back to school for more certifications. Mary Jane had planned a trip with her family to Disney shortly before her death.

That fateful May day, the nurse manager grew concerned when she was over an hour late for her scheduled shift. The police was called and they went to check on Mary Jane. Unfortunately it was already too late.

Let’s work together to ensure patients and those who care for them are receiving the care they deserve. It is about time we also focus on prevention of second victims with bad outcomes.

Sonali Dhir is a new nurse practitioner. She has worked as a registered nurse for seven years. She loves to travel, care for her family. She lives in New Jersey.

From Being a Nurse to a Patient

“ You learn about those who truly care for you in your darkest of times, for they appear to be the light out of the darkness.”

At the age of twenty-eight  I was a  nurse and working on a step down unit and a nursing home setting depending on my two employers’ needs. Overall I felt like I was healthy, I was going to school for my masters degree. I never expected to have difficulty with my health at this point. In January of 2016 I hurt my back and was put out on leave for about a week. I slowly but surely recovered or so I thought. Some weeks later on March 6th 2016, a Sunday night as I was winding down my shift at my nursing home position, I kept urinating and feeling like there was an issue with my bladder.  I thought at first it was the bubble tea I had earlier that evening when some of the other nurses asked me if I wanted anything from the Thai place. After a while I stopped drinking the bubble tea. I had some cranberry pills and drank lots of water. I told one of the other nurses, “ I may have a UTI.”

I went home thinking I would  try to see my doctor the next morning and get seen. Unfortunately as the night went on I was unable to void. I kept pushing and I could barely get anything out. By 1:45am I could not urinate at all. I felt like my insides had closed up preventing me from releasing the urine from my bladder. My parents heard me rushing back and forth to the bathroom and asked me what was wrong. Close to 4am I laid on my bed curled up in fetal position admitting defeat.

I admitted then I need to go to the ER. My parents are  not in the medical field. Therefore when I got the point across that  I needed to get the urine out, and it was something that required a hospital.

We arrived in the ER after 4:30am. The doctors and nurses often left me alone after I was placed in observation. At first they assumed I had a kidney stone. It would be several hours after I convinced them I was not pregnant and a bad CT scan they realized they needed to bladder scan me. A negative pregnancy test preceded prior to the bladder scan which should have been done before they sent me to CT hours ago. After some more time and three attempts of unsuccessful straight cath, they inserted a foley which drained over 1500 cc of urine out of my body. Finally my discomfort waned. The foley remained off an on next few days before a decision was made by my urologist that would remain inside of my bladder until they figured out the cause of my inability to urinate.

Days later  they discovered I actually had a mass in the bladder. My left kidney had lost most of its function. But there was good news. The right kidney miraculously retained over eighty percent of function. Now the goal was how do we solve the problem of fluid on my kidneys which led to me not being able to pee on my own?

My urologist worked relentlessly to get me to a gynecology urology specialist  and a urology oncologist. Surgery was scheduled for March 24,2016. For the month I was out of work and school, I had to get my foley changed six times. Late March I received the news that the tumor was benign. My family and I sighed with relief.  My sister was my greatest support. I had some great friends from work that came to visit me and others  I have known for several years.

I learned who my true friends and supporters were. On April 5,2016 I returned to  the hospital I worked at to get my routine tb testing done for work. I decided to  walk up to my unit. I was foley free. I happily told my coworkers  I did not need a foley anymore. I also did not have cancer.

April 10th, 2016, I returned to work and  a month later resumed my education towards my masters degree.

Through my experiences,  I gained more compassion for my patients and management of their care. I will admit I was depressed for some days, but once I recovered , the experience remained a nightmare that I hope never returns.

 

 

Sonali Dhir is a new nurse practitioner. She worked as a registered nurse for seven years. She loves writing, her family, taking care of her parents and traveling. She lives in New Jersey.