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Andy Nelson, RN

Being a nurse with hearing loss has its challenges. For Andy Nelson, learning how to navigate the communication barriers in the health care setting while maintaining patient privacy was an early challenge.

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By Lisa A. Goldstein

Being a nurse with hearing loss has its challenges. For Andy Nelson, learning how to navigate the communication barriers in the health care setting while maintaining patient privacy was an early challenge. Many people questioned how effective Nelson would be as a registered nurse (RN) with hearing loss. His hospital mainly communicates via a medical text messaging system, which has been helpful. “Being given the proper tools to perform my job has helped not only me but allows others to see that I am able to perform my duties in a safe manner for our patients,” he says.

Nelson lost his hearing at six months of age from spinal meningitis. He wore bilateral BTE hearing aids until he was about 20. He got his first cochlear implant in March 2000. Since then, he has had two internal device failures but currently has bilateral CIs.

After his family’s restaurant, which he managed, was sold, Nelson turned to health care. He wanted to do something that made a difference, required critical thinking, had great opportunities for advancement and change, and provided a decent income.

Nelson trained to become a certified nursing assistant (CNA) at a memory care facility. There, he got to know the RNs, who all loved their jobs. If any got tired of working at one place, they had a plethora of options to choose from. Nursing checked all of Nelson’s boxes; he knew this was the path forward.

Becoming an RN

Becoming an RN, however, means taking the required prerequisites before applying to nursing school. This was the hardest part for Nelson. Once he got into nursing school, it was fairly easy for him since he was motivated. Now he’s coming up on his fourth year as an RN in the Intensive Care Unit (ICU).

Nelson initially wanted to work in the Emergency Department (ED) because he loved it when doing his clinical rotations there during nursing school. In the final quarter, students did a preceptorship and could list their top three specialties. Nelson’s first choice was the ED at a local Level II Trauma Center. His nursing instructors placed him in the ICU instead, despite his having no knowledge of what exactly it entailed. When he asked about it, they simply said, “Trust us, you’ll love it.”

“First night in the ICU, I was hooked,” Nelson says, “and haven’t looked back since!”

Challenges

Nelson’s hospital is a Level II Trauma Center in WA. He works in the Neuro/Trauma ICU, where they pretty much see every type of trauma, from major incidents, strokes, respiratory failures, critically ill COVID patients, to virtually anything that requires an ICU level of care.

Perhaps the biggest issue for Nelson is being able to keep up with the fast pace. Pre-COVID, it was challenging to participate in codes (when a patient either stops breathing, loses a pulse, or becomes unresponsive), because once a code is called aloud, 15-20 people cram into a tiny room following an algorithm to resuscitate the patient. People are busy doing and asking for things and giving orders. Nelson stood by the door and acted as a “runner,” getting needed supplies or medications, or performed chest compressions. Now he says it’s exponentially more difficult because everyone is required to wear masks at all times in the hospital.

“I am very lucky to work in the unit I work with because they all understand that I need to be able to lipread when communicating with them,” Nelson says. “For the most part, they remember to pull their masks down when talking with me. In urgent situations, this isn’t always possible, and being able to recognize when I need to step aside and let others take over was something I had to learn. At the end of the day, all that matters is patient safety.”

Unrelated to his hearing loss, Nelson once spent a week in a Croatian hospital after essentially breaking both legs while on vacation. No interpreter services were available, nor did they seem to care. In the U.S., the law requires providing interpreters trained in medical lingo

“It was a very interesting perspective for me as a patient, not knowing the language or what was going on at the time,” Nelson recalls. “It gave me an appreciation for what our patients go through, especially when English is not their native language. As a result, I take my time communicating with them as permitted. In the ICU, having some flexibility and a ‘go with the flow’ attitude helps because things are constantly changing.”

Nursing During COVID

COVID has been a huge challenge. Nelson and his managers agreed that it would be best if he did not float to the COVID unit because it wasn’t the safest place for people to be pulling their masks down to communicate with him. He has mainly stayed in his home unit, which has worked well. It’s hard seeing everyone in a mask because he is a very visual person and misses being able to communicate and to see facial expressions.

“Every person I come into contact with, I have to explain that I need for them to pull their masks down in order to communicate with me (within reason),” Nelson says. “It gets tiring. Some people have no clue and never pull their masks down. Others only pull their masks down below their nose. But the vast majority of people are understanding.”

Advice

Nelson obtained his associates degree in nursing from a community college and would like to someday get his bachelor of science in nursing. He warns people interested in this career path to be prepared for hard work. Having a hearing loss makes it even tougher.

“But do not let anyone dissuade you from pursuing it just because of your hearing loss,” he says. “Realize that it isn’t for everyone, have thick skin, but be compassionate and understanding of what others are going through.”

Andy Nelson, RN

Ser enfermero con pérdida auditiva tiene sus retos. En el caso de Andy Nelson, aprender a sortear las barreras de la comunicación en el ámbito de la asistencia médica y mantener al mismo tiempo la privacidad de los pacientes representó un reto inicial. Muchas personas se preguntaron hasta qué punto Andy podría realizar un buen trabajo como enfermero con licencia (RN, registered nurse) teniendo una pérdida auditiva. En el hospital donde trabaja la comunicación se realiza principalmente a través de un sistema de mensajería de textos médicos, que resulta de gran utilidad. «Disponer de las herramientas adecuadas para realizar mi trabajo no solo me ha ayudado a mí, sino que permite que otras personas puedan comprobar que realizo mis funciones de una manera segura para nuestros pacientes», explica.

Andy perdió la audición cuando tenía seis meses debido a una meningitis espinal. Utilizó audífonos retroauriculares bilaterales hasta la edad de 20 años y recibió su primer implante coclear (IC) en marzo de 2000. Si bien experimentó posteriormente dos fallos de dispositivos internos, actualmente utiliza IC bilaterales.

Tras la venta del restaurante familiar que Andy administraba, su interés se dirigió hacia la asistencia médica. Deseaba trabajar en alguna actividad con repercusión social, que requiriese un pensamiento crítico, en la que hubiese grandes oportunidades de progreso y cambio, y que le permitiese obtener unos ingresos razonables.

Andy realizó estudios de asistente de enfermería certificado (CNA, certified nursing assistant) en un centro de atención especializado en memoria. Allí es donde conoció a los enfermeros con licencia (RN, registered nurses), a los que su trabajo les encantaba. Cuando se cansaban de trabajar en un determinado lugar, disponían de numerosas opciones para elegir. La enfermería reunía todos los requisitos de Andy, por lo que decidió que era el camino a seguir.

Convertirse en un enfermero con licencia

No obstante, para convertirse en un enfermero con licencia es preciso cumplir unos requisitos previos que se necesitan para solicitar la incorporación en una escuela de enfermería. En el caso de Andy, fue la parte más difícil. Una vez incorporado en la escuela de enfermería, todo fue bastante fácil ya que se sentía motivado. Actualmente, lleva cuatro años trabajando como enfermero con licencia en la Unidad de Cuidados Intensivos (UCI).

Inicialmente, deseaba trabajar en el Servicio de urgencias porque le encantaba hacer allí las rotaciones clínicas cuando estudiaba en la escuela de enfermería. En el último trimestre, los alumnos realizan prácticas profesionales e indican sus tres especialidades principales. La primera opción de Andy fue el Servicio de urgencias de un Centro de Traumatismos de Nivel II local. Sin embargo, sus instructores de enfermería le asignaron a la UCI, a pesar de que no sabía exactamente en qué consistiría el trabajo. Cuando preguntó al respecto, simplemente le dijeron: «confía en nosotros, te encantará».

«Me enganché en la primera noche en la UCI», dice Andy «¡y nunca me he arrepentido!».

Retos

El hospital de Andy es un Centro de Traumatismos de Nivel II situado en Washington. Trabaja en la UCI de Neuro/Traumatismos, donde se tratan todo tipo de traumatismos: incidentes graves, ictus, insuficiencias respiratorias, pacientes con COVID en estado crítico y prácticamente cualquier afección que requiera un nivel de asistencia en la UCI.

Tal vez el mayor problema de Nelson sea poder seguir el ritmo acelerado. Antes de la COVID, le resultaba difícil participar en «los códigos» (cuando un paciente deja de respirar, pierde el pulso o deja de responder) porque, una vez que se dice un código en voz alta, 15-20 personas se reúnen en una sala pequeña y siguen un algoritmo para reanimar al paciente. Suelen estar ocupadas haciendo tareas, pidiendo suministros y dando órdenes. Andy se situaba en la puerta y actuaba como «mensajero», obteniendo los suministros o medicamentos necesarios, o realizaba compresiones torácicas. Actualmente se da cuenta de que era exponencialmente más difícil porque todo el mundo debía utilizar mascarillas en el hospital en todo momento.

«Tengo mucha suerte de trabajar en esta unidad porque todos saben que necesito poder leer los labios cuando me comunico con ellos», dice Andy. «Por lo general, recuerdan bajarse la mascarilla cuando hablan conmigo. En situaciones urgentes, no siempre es posible y he tenido que aprender a reconocer cuándo debo hacerme a un lado y dejar que otras personas tomen el control. A fin de cuentas, lo único que importa es la seguridad del paciente».

Sin relación alguna con su pérdida auditiva, Andy tuvo que pasar una semana en un hospital croata después de romperse prácticamente ambas piernas durante unas vacaciones. No había servicios de interpretación disponibles y tampoco parecía que les preocupase. En los EE. UU., la ley exige que se proporcionen intérpretes formados en la jerga médica.

«Como paciente me resultó una experiencia interesante no conocer el idioma ni lo que estaba pasando en ese momento», recuerda Andy. «Pude darme cuenta de lo que experimentan nuestros pacientes, especialmente cuando el inglés no es su idioma nativo. El resultado es que dedico tiempo a comunicarme con ellos según lo permitido. En la UCI, la existencia de una determinada flexibilidad y una actitud de “adaptarse a las circunstancias” sirve de ayuda porque la situación cambia constantemente».

Enfermería durante la COVID

La COVID ha supuesto un gran reto. Andy y sus superiores acordaron que sería mejor que no trabajase en la unidad de COVID porque no era el lugar más seguro para que las personas se bajaran las mascarillas para comunicarse con él. Ha permanecido en su unidad inicial donde realiza una gran labor. Le resulta difícil ver a todo el mundo con una mascarilla porque es una persona muy visual y extraña poder comunicarse y ver las expresiones faciales.

«A todas las personas con las que entro en contacto tengo que explicarles que necesito que se bajen las mascarillas para comunicarse conmigo (dentro de lo razonable)», explica Andy. «Resulta agotador. Algunas personas no se enteran y nunca se bajan la mascarilla, otras la bajan solo hasta la nariz, pero la gran mayoría lo entiende».

Consejos

Andy obtuvo su título de asociado (Associate Degree) en enfermería en una facultad comunitaria y le gustaría obtener algún día una licenciatura en ciencias de enfermería. Advierte a las personas interesadas en esta trayectoria profesional que se preparen para el trabajo duro. Si se tiene una pérdida auditiva todavía es más difícil

«Sin embargo, no hay que dejar que nadie te disuada solo por la pérdida auditiva», añade. «Hay que darse cuenta de que no es una profesión para todo el mundo, ya que se debe tener bastante aguante, ser una persona compasiva y comprender por lo que pasan los pacientes».

 

 

 

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