Guest Post from an ICU Nurse

This is so well written. I really wish that I could write this well. I demand that this Nurse starts to blog!!

My name is not Catharine. My name is "Nurse!" Not "Nurse?" Or "Nurse." But "Nurse!" Sometimes "Nuuurrrrsssse!!!!" That is what I'm called by the patients (if they can talk), their families, the doctors, social workers, dietitians, respiratory therapists, chaplains, visitors, physical therapists, everybody calls me "Nurse!" I'd sooner be called c*nt, b*tch, f*ckface or wh*re because calling me "Nurse!" amounts to a Master calling a slave. And slave I am.
In my job I am not allowed to curse under my breath, disagree, look serious or speak my mind. I am not allowed to be anything less than warm, friendly and accommodating. Male nurses, of which there are many in critical care, are not held to the same standards. As long as they are knowledgeable and skillful, they are considered "good" nurses. Female nurses, no matter how knowledgeable and skillful, still have to do a lot of ass-kissing to be considered "good" nurses.

According to the hospital, nothing is more important than "customer service." Never mind that I am not selling anything, that I am working with patients, not "customers." I am servicing. Above all, I must service the whims and fancies of the patients (yes, people really do ask me to fluff their pillow), their families (an empty plastic pitcher is thrust in my face along with the command "ice!"), the doctors (no example needed), my manager, and to a lesser extent, my coworkers. In this age of consumer medicine, "servicing" has become more important than providing the actual nursing care for which I studied, was trained and practice according to the highest possible standards and latest research.

Despite the pretense of the "team" approach in our ICU, my opinion doesn't mean much. A few Attendings will ask if there are any "nursing issues," but not many. Nevertheless, because I want the best for my patients, I often "cover" for physicians. I say nothing when an intern presents my idea as his/her own during rounds. I order important labs and x-rays when the medical team "forgets." I spend an extraordinary amount of time explaining a patient's diagnosis, reviewing the plan of care and answering questions honestly and in a way that the family can understand, which often allows the time a physician spends with the family to be more efficient.

I have too many fingers to count the number of times in the last ten years a physician has thanked me for my efforts.

I had to laugh the day an intern was in the room with a patient who started to code (hadn't I been warning him for hours that this was going to happen?!) and the doctor desperately called out, "I need a nurse!" It wasn't about the tasks that needed to be done. This young fellow had no idea how to run a code. But that's how it is in a teaching hospital.

Nurses get no respect. It always hurts to see a patient's family, who has been rude and demanding and condescending to me for hours, bow and scrape and fall apart with gratitude when a doctor enters the room. Don't get me wrong. I have enormous respect for physicians. I am stunned by the intelligence, commitment, compassion and the huge amount of responsibility that doctors bring to the table. But a nurse is always, well, just a nurse. Somehow it is easy to forget that the person who keeps the patient clean, dry and comfortable, the person who makes sure that labs and other diagnostics are done, the person who administers the necessary medications and treatments, the person who manages the continuous dialysis, keeps an eye on the ventilator, collects and records the data, does the wound care, cleans up the shit, blood and vomit, educates and addresses the emotional needs of the patient/family, has the greatest risk of exposure, uses her knowledge and judgment to do exactly what needs to be done at exactly the right time, must stomp her feet in order to get the resident to listen when a problem is developing, in short, the person who keeps the patient alive minute by minute, is just a nurse. And when the time comes, it is the nurse who makes damn sure that the patient dies with as much comfort and dignity as possible.

Nursing is not highly valued as a profession. Nursing (especially critical care) demands a broad knowledge base, advanced technical skills and a great deal of judgment. It seems that we are suffering from a collective historical hangover from the days when nursing was unskilled "women's work." Plumbers make more money and nobody dies if they have a bad day. And I admit nurses are better off in the US than in most other countries. When my mother-in-law tells her friends in Serbia that I am a nurse, she might as well be telling them that I am a street sweeper. Let's face it: How many of you are hoping your kid will grow up to become a nurse?

In fact, with the exception of Halloween night in 1971, I never wanted to be a nurse. I was going to get my PhD in Philosophy. But then it hit me that I had a family to support and that changed everything.

As it turns out, becoming a nurse is one of the best decisions that I have ever made. I can't imagine any other job that would give me the same opportunity for meaningful, authentic human contact. I have provided comfort. I have eased suffering. I have protected the vulnerable. I have grieved with families. I have met needs that are real and immediate. I work tirelessly to keep people alive. I am a staunch patient advocate. I have seen many die but I have also saved a few lives. This work happens in a place much deeper than class, race, gender, sexuality, etc. Being a nurse has taught me more about being a human being than a PhD in Philosophy ever could.

So, yes, I am in many ways a slave. Many see nursing as nothing more than following physician orders (and be "caring" while you're at it!). I work in an ocean of blood, shit and tears that the average person just can't imagine. My work is hard (mentally, physically and emotionally) and in general, I do not recommend it. But at the end of my fourteen hour day, when I come home cursing and complaining, barely able to take another step, I know that I have done something meaningful, something real. And that, somehow, makes it worth it.