I met a fellow nurse at a wedding recently who, upon hearing that I worked at a long-term acute care hospital (LTAC), shrugged his shoulders and said, “Oh, sure. A lot of turns.”
I shrugged, too. He had belittled my work, but in a way, he was right. We do execute “a lot of turns” at my hospital. We complete at least one turn every 2 hours per patient. With an average of 25 patients on the unit, my team will potentially dole out 300 turns per day. Turns — as well as other evidence-based interventions — are fundamental to the survival of bedbound patients.
Perhaps I didn’t bother defending my work because I run into reactions like his all the time. I’m used to it. Among health care workers, the reputation of LTACs is lousy. I find that this disfavor has little to do with the quality of services provided and more with a gut reaction to the nature of these facilities. LTACs are often a repository for bedbound patients who are on life support indefinitely. They can’t move. They are incontinent. They need a lot of turns. And in a health care culture that venerates emergency surgeries and dazzling cardiac innovations, the grim, hopeless haul of the LTAC is a hard thing to admire.
I get it. Having to roll another human being in bed to keep them from developing wounds is sad and repulsive, especially when the prognosis is poor and there is no end in sight. It’s inglorious. What is an act of duty and compassion on part of the nurse becomes something vaguely sinister — as if we are torturing the patient and defying natural order for personal gain.
Perhaps I could have told this nurse how the ethical side is a frequent discussion point at our multidisciplinary conferences. At my hospital, no patient is bullied into staying on life support, just as no patient is unlawfully deprived of it; the decision is made by the patient or by his proxy after many conversations involving physicians, nurses, case managers, and therapists. Our performance as providers should not be measured by the patient’s choice of code status but rather by our efforts to communicate, listen, and inform.
The ones who choose to discontinue life support and let the disease run its terminal course are often praised as brave and gracious; likewise, it is tempting to criticize the ones who continue with full treatment as being stubborn or in denial. But that we have legal dominion over our healthcare fates is a privilege with the potential to provoke. We cannot have it both ways: always free to choose and always in agreement with one another’s choices.
By the way, regardless of code status, we continue to provide our patients with a lot of turns.
Not all of my patients require a lot of turns forever. Sometimes we enter a room to reposition a patient only to discover that he has, for the first time in months, turned himself in bed. This milestone is the result of a long and bitter fight against infection and atrophy. If all goes well, other milestones will follow: weaning off artificial ventilation; learning to eat and speak again; restoration of continence; and discharge to a skilled nursing facility (or even sometimes to home).
Perhaps what I should have said to the nurse at the wedding was, I hope you never find yourself in a bed at my hospital. But if you do, be grateful for the turns. And be grateful for the choice.
Justin Millan is a nurse.
Image credit: Shutterstock.com
