“Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts. “
– Florence Nightingale
“You might be a nurse if you firmly believe that “too stupid to live” should be a diagnosis.“
– Author Unknown
I am going to step out of my norm today, yet stay close to my heart. As some of you know, I am an RN (though I am not currently practicing). The American Health Care System is a disaster. Probably worse than the Public Education System, but that is a completely different story.
I loved my job. It doesn’t feel accurate to even call it by that name though. It was more of a calling.
Nursing. It is an idealistic career path. It is so entrenched within our society, that each of us has an image of what a nurse looks like, what the type of work is like, even what the ideal personality is like.
The typical nurse is not a 20-something, thin, attractive, seductive female.
The work is not composed of bed baths and carrying a cup of pills to each patient.
The typical nurse is not as sweet and caring as Mrs. Cleaver was in the 1950’s.
In today’s job market, nurses are comprised of an extremely wide population base. More and more men are entering the nursing field, as the job market has remained steady, and the starting salary is outstanding (as is the opportunity for overtime). Nurses work everywhere from clinics, to Physician’s practices, to Operating Rooms, to Hospital wards. The average nurse is much older than one may assume, and in my experience they are typically middle-aged, entering nursing as a second career, or after mothering their young children. Also, their is a large percentage of Filipino nurses, and nurses from other nationalities. The opportunity for education and well-paying job in the United States is exponentially greater than in their homelands.
So it breaks down this way: about 25% male (and growing), 75% older than 40, 40-50% are from foreign countries. Oh…and at least 2/3 are overweight/obese – the long hours and high stress isn’t conducive to a balanced diet and regular exercise. Not the seductress we all imagined, is it?
When go to our “mind’s-eye” and imagine what the nurses who take care of us and our loved ones will behave, we think of warm memories. Oftentimes, memories of a mother coddling us as sick children, bringing hot chicken-noodle soup and icy Coca-Colas. This isn’t what you will find in healthcare today.
Nurses are overworked and underpaid.
They have to deal with the public, from every socioeconomic background. We get to see the greatest strength humans are capable of, and we all have dozens of stories of real-life miracles.
We also get to see people at their absolute worst. People who are unable to shower themselves, let alone control their bowels. People who can’t even sit up in bed because they are in excruciating pain. People who have wounds so large that you can fit your hand inside areas that hands shouldn’t be able to enter.
Obviously, if you find yourself in any one of the aforementioned situations, you will NOT be a happy camper. And you will be pissed off at God, and the world. And who do you take it out on? Your helpless nurse.
This being the case, after the first couple months on the job, the nurse typically loses patience and tolerance. They are bluntly honest. If you refuse care, so be it. The quality of your life is up to you, they have 5 other patients to take care of. They don’t have the time to explain to you why a certain treatment has been ordered, or why you have to go through a particularly painful procedure. “Its what the Doctor ordered” is what you will often hear. They will be easily annoyed by your requests for an additional blanket, or another cup of ice.
It doesn’t have anything to do with you personally, it is just the nature of the work. Almost every nurse has a passion for helping their fellow man. Sure, the job outlook and employment opportunities may have been what led them to choose nursing, but NOBODY enters a career like this, or stays for long unless they have a true heart for helping others.
Which leads to the third, and possibly most important area I want to address…
Most nurses start their careers in the hospital. Not many stay there for long. So usually the nurses you will see in your Doctor’s Office, or in health clinics are nurses who quickly became disgusted with the conditions on the front-line of healthcare.
For this reason, I will focus on the Hospital Environment.
For starters, the typical shift is 12 hours. This can easily turn into 15, when you account for emergencies that ALWAYS seem to happen at about 6:45, right before shift change. Add to that the fact that you must chart EVERYTHING you do throughout the day, and you usually don’t have more than 15 minutes to sit down and chart a single thing.
Charting is important – it helps to minimize mistakes, provides documentation for what care was provided to assist physicians, therapists, and other healthcare practitioners provide a seamless level of care. A nurse just doesn’t have the time to document on the fly.
A lunch break is……wait a second. What is a lunch break!? Occasionally I would have 30 minutes to take a break to eat a sandwich. More often, I may have 10 minutes to run to the cafeteria before they closed to pick up something that was already cold, only to take a few bites as I had time between the next emergency.
I worked on a Step-Down Unit. The hospital typically has 3 levels of care (not including the ER): ICU (Critical Care – the sickest of the sick); Step-Down (where you go after ICU, maybe 2-3 days after a major operation, or once you are considered ‘not sick enough’ to be in ICU, or if they just don’t have any more room in ICU and someone else is coming in); and Med/Surg or Floor nursing (Where everyone goes who doesn’t have a specific diagnosis, or a life-threatening procedure).
Typically, ICU nurses have a 1-2 patient assignment; Step-Down nurses have 3-5 patients; Med/Surg nurses have 5-8 patients.
I will leave it up to your imagination what the ICU and regular floor level of care is like. I have experience in Step-Down, so I will focus here. But I will say this, usually when patients are in ICU they are on a vent, or too drugged up to know what is going on – so they don’t really know what the care is like. On the other hand, families are always lavish with their praise of ICU nurses (who are basically constantly at your bedside, as you are hanging on the edge between life and death).
With 4-5 patients, a typical assignment may look like this:
- Mr. A – 3 days post-op from a major surgical procedure, still has foley catheter, 2 IV’s with fluids/IV meds constantly going, has yet to ambulate out of bed, severe incisional pain (where they cut you), still on O2 via the nose; has not had a bowel movement since surgery.
- Mrs. B – New admission with a tracheotomy (where they cut a hole into your neck so you can breath through it); often these patients are cancer patients, so while under the knife they have all the preparatory procedures for the coming months of chemo (teeth are extracted, a feeding tube is put in – a tube into your stomach, where a liquid food is poured in, etc)
- Mr. C – Had a Right Leg amputation above the knee 4 days ago; you have to prepare to send him to the regular floor to make room for other patients coming – this means you are need to make sure he can ambulate to the chair (with assistance from you or physical therapy), you have to take out his catheter (tube that goes in to collect urine), and that he passing stools.
- Mrs. D – Former kidney transplant patient, who is again in End-Stage Kidney Failure; still must receive daily immunosuppresant drugs (as she still has cadaver kidney in her body); must monitor labs closely – including electrolytes (Sodium, Potassium, etc.), and blood counts (White blood cells, drug levels); she had a fistula placed in her left arm yesterday (surgical procedure where they connect blood vessels to be used in Dialysis); she is going for her first dialysis treatment this afternoon; she is also suffering from major depression and suicidal thoughts with her failed kidney.
So there you have it. On top of all of that, you will probably be receiving another patient from either the ICU or OR once you transfer Mr. C to the regular floor. I don’t need to go into all the details of what you need to do in order to provide adequate care, but I will make a note of possible problems that could occur.
- Mr. A – you need to keep close eye on his pain, and his incision and tubes – he is at high risk for infection right now; also need to monitor vital signs (Blood pressure, temperature, etc.), because being so soon out of a major operation, these can still change on a dime (and then you could have a Code Blue…NOT good).
- Mrs. B – Will need to monitor her breathing at least 4x/hour – typically have large amount of secretions in the first day or two after this procedure, and you will need to insert a tube down her throat to suction the mucus out that she is unable to clear; also important to maintain positive body image, and depression is common following this procedure; communication is difficult, as she can no longer speak for at least the first several days; also need to monitor bleeding – occasionally can be bleeding inside their windpipe (and when mixed with a little bit of secretions, can make a HUGE mess).
- Mr. C – need to make sure his wounds are clean and healing; need to remove catheter; need to make sure everything looks as hunky-dory as possible (no signs of infection) before transferring him away.
- Mrs. D – Huge electrolyte imbalances are possible with kidney problems; need to closely monitor her fluids in and out, as well as her diet; if electrolyte changes do occur, can lead to severe problems (including cardiac arrest).
On top of all of this, you are expected to chart on each patient every 4 hours. Any of the above problems can, and mostly likely WILL go wrong at any time, sometimes more than one at the same time. You will have several family members for each patient who think there is nobody more important, and nobody more sick than their loved one, and they expect you to be there for their every need. And of course, you have the patient who is constantly in pain, and needing to be doped up ever 1-2 hours.
And all of this requires additional documentation.
In conclusion my friends, you can see why I have been reluctant to return to this line of work. The experiences can be more rewarding than money could ever be, and I cherish every patient, every colleague, every moment I had while I worked in the hospital.
From the age of 22-24 I worked full time as an RN. I saw things and experienced things that most men at that age can’t even imagine. It has shaped me as a person as much as anything else, and has left an impression on my life that will always exist.
I cried with patients. I helped the elderly slip peacefully into the afterlife. I have cracked ribs under the pressure of my hands while performing CPR. I have changed dressings where a grown man is screaming in pain, as his femur is exposed (the leg bone above the knee). I have celebrated with patients as they have returned to health, and a way of life they only knew in decades past. I have listened to stories of trauma and loss. I have seen young men and women afflicted in ways that would render them dependent for the rest of their lives. And I have seen grandparents receive a gift through modern medicine that allowed them to enjoy life once again, and enjoy time with their grandchildren for the first time.
I miss it. I loved it and I hated it. I will never be the same because of it.
But I will only return if I am able to provide the care that every person deserves upon entering the treacherous healthcare system in today’s world. Too many people are sick, and there aren’t enough people to take care of them.
And the almighty Dollar dictates it all.