Random Thoughts and Stories

Once in a while I start blogging and then run out of steam. I have many many saved half posts stored on this blog that have never been finished or published.  Here are some thoughts I had.

A Nurse can care for all of her patients some of the time, or she can care for only some of her patients all of the time but she CANNOT care for all of her assigned  patients all of the time.  There are just too damn many of them and constant interruptions to boot.

An example of this that springs to mine is what I saw happen to Mary, a Nurse on my ward in England.  She had a patient start bleeding profusely out of his gastrointenstinal tract.  Earlier in the shift she had recognised that he had potential to crash and she prepared for it.  And he did suddenly crash.  All of the sudden that patient was losing consciousness, his eyes were rolling to the back of his head and his skin was turning white.  This was happening fast, like over a series of minutes. Mary had 15 other patients at this time who were all waiting on scheduled meds, treatments, discharge papers, requesting pain relief etc.  Mary put the call out for her bleeder, got about 100 orders to initiate thrown at her and by the time he was on his way to the intensive care unit it had been 2 hours before she got back to her other patients. Then something else happened and she was again kept away from her patients for a further few hours.  Staffing will not give a ward an extra nurse during a situation like this.  It is one Nurse to 15 patients no matter what.  That is what the ward is budgeted for. We don't get extra help if we suddenly have sicker patients.  The number is fixed. The ratio can go down a Nurse but not up.

The family of the bleeding patient wrote a long thank you note to Mary.  They were impressed at how fast she moved to get their father the help he needed, and how on top of things she was.  They wrote a long letter to administration about how wonderful Mary was.

On the same day that administration got the letter applauding Mary they also received letters condemning her.  These letters were from the other 15 patients that got the shaft because Mary's bleeder was sicker than they were.  They condemned Mary as a vile uncaring Nurse who ignored them for hours and didn't bother to bring their meds on time. 

This happens a lot.  Unless you understand what is going on with your Nurse's (or doctor's) other patients and what it involves and time frames involved you aren't really going to grasp how it is going to effect your care.  I might want to go over your medications and tests with you, but I can't if one of my demented patients just pulled out his central line and caused himself a pneumothorax.  I might want to get to you with your pain meds but it ain't going to happen if one of my patients suddenly and without warning goes into a 19 beat   run of Vtach on the monitor and I got to sort him out and transfer him to CCU.  There is nothing I can do to stop those things from happening at the same time so many of you need me for something else. As you are always sharing your Nurse and Doctor with way too many other patients it might be a good idea to get to grips with the concept of triage and prioritisation. 

My sister in law called me on the phone.  She told me that she was 'JUST LIKE A NURSE' because her kid was sick and she stayed home from work to make him chicken soup and cuddled him on the sofa. "I guess I was a Nurse today just like you, Anne" she says.

I nearly fucking ripped her head off for saying that.  First of all if you are not so laden with anxiety that your hair is falling out you are not anything like a NURSE.  Being a Nurse involves being assigned way more patients that you can handle every single day, day after day.....some of them  are so sick it's like if you blink twice they're dead.  Many of them are non complaint and abusive, with extensive drug and alcohol abuse and psychiatric histories.  You can't even come close to doing the things that you need to do for them because of their behaviour, the acuity on the ward in general as well as the short staffing yet you have total liability.

I wanted to say "Listen dumbass, when you spend 14 hours afraid that you are going to be held responsible for someone getting hurt or dying because you can't be 100 places at once then you will have some kind of clue about what being a hospital ward Nurse is about. Until you experience that complete liability and blame with no control you can just shut the fuck up. Taking care of your sick kid, dog, spouse, grandma is not the same thing at all." 

Doctors have more stress but they also have much more control, which helps manage the stress. But anyway as you can see it doesn't take much for me to snap at family and friends with their dumb ass comments about "Nurses".  The cousin who asked me what the hell it is a Nurse actually has to do at night "because all the patients are sleeping, right" no longer has a scrotum.

I feel nothing anymore.  I was talking to a friend from school who is also a Nurse.  I was telling her (Julie) about how the UK thinks that solving the lack of care in hospitals can be done by teaching nurses about empathy and compassion "the most important part of their job". Whatever. After a shocked silence she responded with "but my god, feeling is the first thing that has got to go if you are going to stay in a job like this, why don't they address RN ratios and resourcing".  I agreed. 

After a few years of general floor Nursing I began to feel nothing, completely numb.  I watched my grandma die of old age and felt nothing.  Honestly, I got to the point where I could have witnessed a plane full of kids crash and not even bat an eyelash.  You just go numb and just try to survive.  It's a defense mechanism. Some Nurses get like this after a few months of the job and with others it takes years.  One day you just realise that you have no feelings anymore and you realise that you have to quit.  People who leave bedside Nursing tell me that feelings do come back again eventually. Having got out of the short staffed clusterfuck hospital I worked in when in England, I have to say that I do believe that this is true. You can't put Nurses in these kinds of situations (21st century clusterfuck acute care) and expect them to be patient and empathetic.  Like Julie said, those traits are the first thing that go.  They have too.  Nursing is a whole different ballgame from what it was in the 60's.   Bedside Nursing is hell and everyone wants to escape.  If all we dealt with was bedpans, drug rounds, shit and puke we would find our jobs easy and stay at the bedside. 

And don't even get me started on the Uncle who said "I could never be a Nurse like you Anne, I would find blood and puke to hard to deal with" no longer has any eyes because I scratched them out.  Poor Joe didn't know what hit him, he thought he was showing me a mark of respect by saying that.  Blood and puke and shit and piss are probably the easiest aspects of my job.  His comment was an insult.

I am sure lots of "Nurses" will come on here and take issue with what I am saying.  But not one of them will be people who work as QUALIFIED Nurses in Med surg, general medicine, short staffed MAUs or heaving  EDs.  Come to acute care/general medicine and then get back to me is my preemptive comment to them.  I have lived it and I have done my research.  What I say is true.  People who think that Nursing is a soft service style job for soft people with strong stomachs are assholes.

Mentioning my grandma in this post reminds me of something else I will post about. And that post will probably be more funny than disturbing.