DAY TO DAY IN A 20SOMETHING LIFE

You can’t say because I said so in medicine. There’s this thing called evidence based practice. Ya kinda have you follow it. It’s real fun having this conversation with some people.

I’ve been thinking about death. Death in a hospital is so strange. Death to a nurse is even stranger.

We recently discharge a patient who had spent 116 days on our unit. She was crazy and hated everyone. Refused cares, assessments, vitals, everything. Called every morning at 3am on the dot for coffee. She was famous for hoarding anything and everything we took into her room. From boxes of gloves to mouth wash bottles to spoiled food.

We couldn’t wait until she was gone.

A few nights ago we found out that she had been readmitted to a different unit in our hospital. A telemetry unit. We all laughed and couldn’t believe she was back. She had only been gone for two weeks.

Then, a couple nights ago, we heard the call overhead. Code blue. Her room. Myself and the nurse I was working with stared at each other, dumbstruck. We couldn’t believe that the old, stubborn bat that had spent 116 days with us was dying two floors down.

She passed that night. And we did what nurses do. We joked. From the outside I’m sure we all sounded macabre and sadistic, the way we talked about all her outbursts and how she would be hoarding in heaven now. We joked about death like it was a friend. I guess it kind of is.

See, to us nurses Death is a friend. We walk the halls with him, joke with him. We have an agreement. He doesn’t get in our way and we don’t get in his. We let those who have made the decision to do so go peacefully. We stand vigil with Death. He waits patiently as we make sure they aren’t in pain. Drip after drip we fill their bodies with the poison that allows them to meet Death peacefully.

Then there are the other ones. The ones where Death has gotten a little antsy. He hasn’t stuck to our agreement. And we do what we are trained to do. We fight. Violently. We fight for the life that this patient wasn’t ready to give up yet. We yell and we scream at our friend, Death. We break ribs with our compressions. We burn veins with our drugs. And if we are lucky that patient lives and we go on with our friendship, our agreement, with death.

((Beware, this one might not be a popular opinion but I don’t care anymore)) I’m sorry that I’m not focusing enough on how “pristine” your room is while I’m trying to keep you and your baby safe. That I’m not catering to your every whim and bringing rounds of ginger ales for you and your eight family members every 30 minutes. I am not a waiter. Will I bring you ice and ice water and popsicles and jello? Absolutely. You are the patient and in labor. I am here to help you. I will not be an on call butler for your entire family.

I’m sorry that I don’t treat you like you are at a five star resort and spa. That I don’t provide foot rubs, pedicures, back rubs, cucumber water and hot towels for your hands. 

Here’s an idea, if you want to be treated like you are at a five star spa, GO TO A FIVE STAR SPA. Don’t show up at your local hospital. Where I’m overworked, stressed out, haven’t peed in six hours, and haven’t consumed a meal outside of the nurses station in two years. OH, and where I hear constantly about how I’m not doing enough to make my patient’s stay satisfactory, pleasurable, or perfect. 

I’m sorry that I cannot make your pain your desired pain goal of zero. That is not a reasonable pain goal. You are here to have a child. Either out your vagina or through a large abdominal incision. ZERO IS NOT AN ACCEPTABLE PAIN GOAL. You will never have ZERO pain if you are experiencing childbirth (or in a hospital period). Hospitals are not spas or hotels or resorts, in spite of the daily housekeeping and room service. Hospitals are not a pain free experience, no matter how you look at it. 

When EVERYTHING in the hospital is about how wonderful the patient’s “experience” was, you (MANAGEMENT) are focusing excessively on the wrong things. I am your labor nurse. I am here to keep you and your baby safe. I am here to provide the safest, happiest birth experience I can give you. I am here to honor your wishes in every way that I reasonably can. I am here to support you, to educate you, to hold your hair when you puke, and to coo over your beautiful baby when they’re born. I will support you, I will laugh with you and cry with you.  

But most of all I am constantly assessing and evaluating and critically thinking about what is going on with your body, your health, your baby. As I fluff your fifth pillow to give you more cushion in our horribly uncomfortable beds I am also worrying what will happen if your blood pressure drops dangerously low after an epidural, what happens if your baby’s cord prolapses and you need a stat c-section or what happens if God forbid you get an amniotic fluid embolus and you are dead before I can get you out of the room. 

This is what I’m contemplating on a daily basis. I understand this. I understand the responsibility I took on when I became a nurse. 

I’m telling you I cannot continue to be a excellent, safe, careful, competent nurse if I’m worried about getting in trouble with my boss because there was a lunch tray left in my patient’s room mid-afternoon or that housekeeping didn’t come fast enough to mop up a spill or that I didn’t bring my patient enough gatorades. 

I am telling you that focusing ONLY on patient satisfaction scores as a measurement for hospital performance will be the end of bedside nurses.  All the excellent bedside nurses will be gone. We can’t take this. Day after day, year after year. We will go back to school to become NPs, CNMs, educators, or nursing instructors. We will not stay at the bedside. 

We will not stay in a job where we are told our only worth is how “enjoyable” our patient’s hospital stay is. 

I am a nurse. But I will not fight to stay in a job where I get told that everything I do is not enough. That my best is never enough because the patient didn’t mark “Always” enough times on their HCAPS survey. 

1. Thy family member shall realize the nurse is present and responsible to careth for only the patient, not thy family member. Therefore, thy family member shalt not make demands of thy nursing staff for blankets, pillows, drinks, etc. etc.

2. Thou shalt not demand the nurse call thy doctor every minute.

3. Thou shalt not ever expel any bodily fluid onto the person of thy nurse.

4. Thou shalt not act like thou knows better than the teams of doctors and nurses caring for thou self. Therefore, thou shalt not refuse treatments or go against medical advice. If thou doth so, thou shalt go the fuck home.

5. Thou shalt not complain about light & noise in the ICU. Thou art in the ICU, be grateful thou art alive and can see and hear.

6. Thou shalt not fall in the hospital. Repeateth, thou shalt not fucking fall.

7. Thou shalt realize this is a hospital not a hotel.

8. Thou shalt not ask about thy nurse’s age or martial status.

9. Thy family members shalt not stare at the monitor and worrieth over every number. Thy nurse is present and seeth the monitor. Thy nurses also have the medical training and knowledge to asses and act based on thy monitor and thy patient, unlike thy family member. Thou input is neededth not and is in fact, annoying and distracting.

10. Thou shalt not harass thy nurse for refreshments and narcotics. RN standeth not for these things.

11. Thou shalt never attempt to hit, punch or otherwise harm thy nurse. Thou will find thyself restrained if thou threatens thy medical staff.