Books ER Nurses Should Read
Books by nurses:
Trauma Junkie: Memoirs of an Emergency Flight Nurse by Janice Hudson, RN
Reviewed by Megan Oakes, BSN, RN, CEN
As an ER nurse turned flight nurse, I found this book to be a great read! Just like the title suggests it's a perfect read for the trauma suggests it's a perfect read for the trauma hunting, thrill-seeking, adrenaline junkie! Janice Hudson makes her audience feel like they are riding on the helicopter along side her and this quick, fun read will make you want to cry, cheer, and laugh! I highly recommend this read for the ER nurse wanting to fly, the flight nurse bored in between calls, and anyone looking for a fun read about real life events in emergency services.
"Unfortunately, if I allow myself to consider the personal lives of my patients, I can't concentrate on the work at hand. It becomes too painful."
""You guys realize there wasn't a damn thing you could have done for those firefighters. We did what we could."
I knew that, but somehow it didn't seem like we'd done enough."
Books by physicians:
Being Mortal by Atul Gawande, MD Reviewed by Skye Croom, EMT
Medicine used to be largely palliative. Not so long ago there was a time when physicians were not capable of finding cancers and other fatal diseases until it was largely too late to do anything but reduce suffering and pain the best they could. Even infections were typically fatal, not to mention the list of illnesses we now vaccinate for. Penicillin hasn’t been around for a century, and insulin will meet its centennial in a few years.
With progress, we now take for granted the role medicine plays. We are used to seeing people come into the emergency department on their deathbed and being able to give insulin, naloxone, tPA or any number of other life-saving drugs and watch them as they leave that brink. Our patients and their loved ones have become accustomed to the privilege of visiting a doctor and leaving all better, or on the track to getting all better – and perhaps we in medicine have become accustomed to it too (to some extent).
Dr. Gawande’s book Being Mortal discusses this in a new light. He delves into the idea of mortality and confronts it directly. We have soldiers coming home when before they would have died on the battlefield. We have people with chronic illness and fatal diseases surviving much longer than ever historically possible. This adaptation in medicine and the role it plays is thoroughly explored. The book especially focuses on the progression of old age – something we are better able to evaluate now that we have so many people hitting these milestones (and causing an incredulous hardship on our medical system as we are tragically underprepared).
Below are some of my favorite quotes from Dr. Gawande’s book.
"The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible and the retention of enough function for active engagement in the world. Most doctors treat disease and figure that the rest will take care of itself. And if it doesn’t – if a patient is becoming infirm and heading toward a nursing home – well, that isn’t really a medical problem, is it?
To a geriatrician though, it is a medical problem. People can’t stop the aging of their bodies and minds, but there are ways to make it more manageable and to avert some of the worst effects." p. 41
"Functional lung capacity decreases. Bowels slow down. Glands stop functioning. Even our brains shrink: at the age of 30, the brain is a three-pound organ that barely fits inside the skull; by our 70s, gray-matter loss leaves almost an inch of spare room. That’s why elderly people are so much more prone to cerebral bleeding – the brain actually rattles around inside. The earliest portion to shrink are generally the frontal lobes, which govern judgment and planning, and the hippocampus, where memory is organized. As a consequence, memory and the ability to gather and weigh multiple ideas – to multitask – peaks in midlife and then gradually declines. Processing speeds start decreasing well before age 40. By age 85, working memory and judgment are sufficiently impaired that 40% of us have textbook dementia." p. 31
“Always examine the feet.” He described a bow-tied gentleman who seemed dapper and fit, until his feet revealed the truth: he couldn’t bend down to reach them, and they turned out not to have been cleaned in weeks, suggesting neglect and real danger. … [He said to] “inspect inch by inch – the soles, the toes, the web spaces.” p. 40
"As you get older, the lordosis of your spine tips your head forward. So when you look straight ahead it’s like looking up at the ceiling for anyone else. Try to swallow while looking up; you’ll choke once in a while. The problem is common in the elderly. You have to look down [to avoid the issue]." p. 51
Being Mortal provides insight into patient’s lives as they struggle with their loss of independence and shifting cultural role. It provides advice for assessment to determine where our patients are and what resources we may refer them for. The book quotes a not-insignificant number of interesting research to quantify some of our elderly patient’s hardships. You will learn about palliative and hospice care, the role they play, and even what to look for in a nursing home if ever you have to make that decision. There is no doubt this is a worthy title to add to anybody’s reading list, whether they are involved in the medical field, are a patient or a loved one.
The Checklist Manifesto by Atul Gawande Reviewed by David Peace, EMT-P, FPC
The Checklist Manifesto, by Atul Gawande, is a must read for any clinician that hates, loves or doesn’t care about checklist. If you hate using a checklist then the author will convince you that their correct use can make you a better clinician. If you love using a checklist then this book will sharpen your ability to develop highly effective checklists and deploy them in your corner of the world. If you don’t care, then you will start caring and will begin to spot their use and benefit in many of the clinical tasks you perform.
Gawande begins with a history lesson on how checklists were born and explains their potential application to medicine. He clearly demonstrates that practicing medicine continues to increase in its complexity, but human beings remain fallible and capable of error.
“Medicine has become the art of managing extreme complexity – and a test of whether such complexity can, in fact, be humanly mastered.”
Next the author takes you on a fascinating journey into how a good checklist is created and refined, then teaches you the differences between checklists that add value to your practice and ones that do not.
“Bad checklists are vague and imprecise. They are too long; they are hard to use; they are impractical. They are made by desk jockeys with no awareness of the situations in which they are to be deployed. They treat the people using the tools as dumb and try to spell out every single step. They turn people’s brains off rather than on. Good checklists, on the other hand, are precise. They are efficient, to the point, and easy to use even in the most difficult situations. They do not spell out everything-a checklist cannot fly a plane. Instead, they provide reminders of only the most important steps-the ones even the highly skilled professionals using them could miss. Good checklists are above all, practical.”
Finally, the author explains how the use of a checklist can make you a better clinician rather than get in the way or slow you down.
“they improved their (patient) outcomes with no increase in skill.”
The Checklist Manifesto was a fascinating history narrative and a valuable exposition of why you should consider the checklist as a great potential tool that can be utilized to bridge the gap between human error and ever complex and sophisticated medical knowledge. Add this book to your must-read list and join me in placing a checkmark beside it when you are done.
Treatment Kind & Fair: Letters to a Young Doctor by Perri Klass, MD
Reviewed by Skye Croom, EMT
Pediatrician, mother, wife, and author, Perri Klass wrote Treatment Kind & Fair primarily as a series of essays to her son, who at the time had been accepted into medical school. This is a book I recommend not only to anybody entering in medicine – nurse, EMT, paramedic, doctor, physician assistant, tech, etc. – but to people who have been in it a while and want (or need) a reminder of the privilege that is practicing medicine.
I say privilege because it is an honor to serve the patients and their loved ones. We are involved very intimately with total strangers; we learn secrets that even their closest loved ones don’t know, we assess and touch private areas, and we are present throughout some of the greatest hardships they will face in their lives. Dr. Klass reiterates this with eloquence, recognizing the struggle that we will inevitably face, the decisions that must be made, and how everything affects us when we go home at the end of the day. She brings humor into these difficult subjects but never does it seem inappropriate or ill-designed.
Dr. Klass refreshed my young soul in medicine. Her book was strangely grounding – confronting complications in practicing medicine, being a student, leader, and educator; her words are reassuring and inspire confidence in your decision-making yet still inspires well-rounded humility. Altogether, Treatment Kind & Fair merges biography, medicine, psychology, and sociology within the same text in the perfect proportions, and earns my rating of 5/5.
Here are some of my favorite quotes:
“Going into medicine is … choosing to be in a profession that will insert you, again and again, into these moments when people’s lives change, or unravel, or come together, or turn suddenly and sharply in a new and often unwelcome direction.” p. 46
“When you can’t do anything else, listen and pay attention.” p. 42
“I hope that you will always remember … the sense of wonder that people trust you with their bodies, even their sore and painful bodies, trust your probing, and allow you to pass this boundary.” p. 71
“Before you do something to a patient, you have to ask whether it helps, whether it hurts, or whether it does nothing – and you have to ask it in a rigorous scientific way. As you move along your evidence-based way, remember to be humble.” p. 122
“Evidence-based medicine is not the whole story. Doctors are human, patients are human; personality and luck and common sense and comfort all play a role in deciding what to do at clinical decision points.” p. 125
“Make the effort to imagine and understand their lives, to put yourself in the patient’s place. Don’t wall yourself off, and don’t fool yourself into thinking that affections and emotions are somehow unprofessional. And be sure to value the people who help you and support you. Make sure you exercise your growing powers of empathy on the people around you.” p. 216
There is no shortage of clinical stories and lessons, either:
“The blood-brain barrier is a little leakier in young infants; if there are bacteria in the blood, it’s easier for that infection to get into the brain and the spinal cord and cause meningitis.” p. 107
“Children are particularly vulnerable to iron-deficiency anemia from just before their first birthday to the age of two or three, especially those who are still getting much of their protein and other nutrition from milk.” p. 179
Books by paramedics:
A Thousand Naked Strangers by Kevin Hazzard Reviewed by Nyssa Hattaway, RN
Kevin Hazzard was a medic for Grady EMS in metro Atlanta for roughly 10 years. He is now a writer full time; this medical memoir is beautifully written. He spares no details about the realness and the rawness of what our medic friends do. This book is a must read for any emergency provider. I will be gifting it again and again.
"EMS is wild and imperfect. Just like our patients, it's dangerous and a little mad and possibly contagious." p. 8
'"When I step out of the ambulance, his father is waiting, anxious. I tell him his son died, but now he's alive. We brought him back from the dead.
He nods. "Yeah, okay. Look, he's got cigarettes in his pocket," he says, poking his head through the door. "Can you grab 'em?"
"Sir, your son just died. We saved him, but he could die again. We need to hurry. To the hospital."
"But they're right there in his coat pocket." ' p. 195
"The first miscarriage I worked was the worst. Tiny hands, fully formed, curled into fists that dangled from arms attached to the world's smallest human. Nobody told me it would be like this. I imagined blood and pain and a quiet woman. Instead, we got a person in miniature, asleep in the Tupperware. At first our patient wanted to hold him, then didn't and placed him on the stretcher. We hit a bump and the container fell off. He landed in the street, as soft as a raindrop. The process of picking him up and finding a suitable place to carry him was funereal- imagine two ashamed pall bearers in the orange glow of a streetlight." p. 235-236
"There will always be another dead body, another fetid roach-infested house. We will never escape the smells, the fluids, the unwashable ick of people deep in the throes of a communicable disease. We've run these calls- the disgusting, the foul- and we'll run them again. " p. 86
Books by educators:
Effective Communication in Multi-Cultural Health Care Settings by Gary L. Kreps, PhD and Elizabeth N. Kunimoto, PhD
Reviewed by Skye Croom, EMT
Although this is a textbook for college-level courses, and was published in 1994, it reads like something written just last year. Relatively short at 124 pages long, the book discusses inter- and intra-personal communication. There are sections focusing on group communication as well, especially within the hierarchies that are inherent to medicine. One of the great talents of the authors is putting concepts that some of us already know into words. The writing is in some ways repetitive, and there is a surprising, almost humorous amount of self-citation by the very educated and well-published Gary Kreps. When it comes to a textbook, however, it is clear and easy to read, not requiring an excessive amount of cognition to follow along – something I always appreciate because on some nights, I don’t have enough of that cognitive ability left over from my day.
Not only will this book help you as you help treat underserved cultures, including the elderly, it will help you if you have any role in education, either formal or informal. Formally, the text offers advice on leadership and serving your subordinates the best you can. As a paramedic student, I wish some of the staff I am placed with in emergency departments practiced some of the concepts outlined in the books. Inversely, reading this book widens my perspective as a student and lends advice on how to help myself – what to look for, what to be mindful of. Mindfulness, and the Golden Rule, are concepts at the core of this book.
Here are some of my favorite quotes, in no particular order:
“In effective groups, members work together cooperatively. Such groups benefit from synergy, the ability to generate greater outputs through cooperative action. Communication should be used to promote cooperation within groups, enabling group members to work together harmoniously and productively. Unfortunately, cooperation does not always occur naturally, and ineffective group communication leads more often to competition than cooperation.” p. 20
“Empowerment – meaning “to enable,” “to endow,” “to invest,” “to delegate,” “to authorize,” “to sanction” … empowering involves engaged listening by the superordinate in the relationship. Empowering a person means that you take that person seriously, and you demonstrate this by the action you take based on what you hear. Listening and acting on the information from the process reduces uncertainty, a primary barrier to effectiveness in multicultural communication.” p. 53
“There are five primary interrelated health communication problems confronting the elderly in seeking health care:
Their loss of social status within the healthcare system.
Their loss of personal independence and control over their health care treatment.
Limitations in the availability of health care services to the aged.
The growing alienation, loneliness, and boredom of the elderly within the healthcare system.
The increase in fraud and misrepresentation in health care for the elderly.” p. 94
“Be aware that interpersonal interactants seem to need a certain amount of redundancy in communication to enhance predictability, reduce entropy, and help them maintain a comfortable psychological state.” p. 116