On Friday, if anyone were to ask me if I’d recommend nursing as a profession or if I’d be happy if my children told me they wanted to become nurses, I would have said no. My shift started out smoothly. I had a good assignment and I was able to get my two 0730 patients into the OR safely and without delay. As I was reading over my third patient’s chart, one of my coworkers asked me to look for IV access on one of her patients.
Prior to entering the room, I learned that variables that classified this patient as what we call a “hard stick”. I entered the room and introduced myself with a smile and told the patient I’d give her IV a try. I felt confident. I’m good with hard sticks. I take my time and I’ve been complimented by multiple patients that my technique is gentle. This patient was tricky but I felt a few small veins in her hand and I decided to use a smaller gauge needle. IV needles have a bevel at the end and the technique requires us to puncture the skin with the bevel up. Upon entry of the needle, we wait until we get a blood return before we advance the needle into it’s final position. After that, we click a button and the needle retracts into the handle and the jelco is left in the patient’s vein. I prepped the patients skin and held her hand with my left hand, pulling the skin down to secure the vein under the skin. As I punctured the skin, bevel up with not even a big enough portion of the needle in her skin to even maneuver the needle, she let out a blood curdling scream at the top of her lungs and in my face. My body jerked and stiffened immediately and I froze for a second. My initial reaction was shock and I tried to quickly regroup and continue with the task of this difficult IV stick. I was too distracted and shocked though and decided I couldn’t proceed. I covered the needle with gauze and removed it. I applied a piece of tape and pressure to the site, looked her in the eyes and said, “I am sorry if I hurt you. You really startled me”. She really didn’t give me a chance. Shortly afterwards, the shock turned into anger. I washed my hands and quickly exited the room. I managed to escape without the patient realizing that I was angry. Three of my coworkers were standing outside of the room with their mouths hanging open. Someone else told me the screaming could be heard on the other side of our unit, forty yards away. I was thankful that this patient was not assigned to me because I although would have taken good care of her, I would not have been able to feel empathy for her. It took me several hours to shake off the screaming, the shock and anger.
Later on, I received my sixth patient of the day from an inpatient unit. She had five family members with her. As a rule of thumb, most nurses do not allow that many family members in the room when there is care to be provided with time constraints. I personally find it disruptive to my care to have that many people at once in the room so I politely asked them to choose one person to be in the room with the patient during my care and promised the rest of them can return afterwards. They agreed and chose the patient’s son. Everything was fine until the son became argumentative during parts of my interview. He didn’t like the way I described the Advance Directive question that we are required to ask. He interrupted me when I was doing the pain scale assessment and insisted that his mother didn’t understand. I matter of factly explained that I wasn’t finished with the pain assessment yet and hadn’t determined if the patient understood it or not because he interrupted me. I proceeded to question the patient on her pain tolerance and as it turned out, the patient did understand and answered the question appropriately. I completed the pre-op interview and called the rest of the family into the room until it was time for the patient to go into surgery.
The two scenarios that I just described occur more often that nurses wish to to reveal to people outside of the health care industry simply because most people just don’t understand. It happens to all of us, in some form every day. In addition to the many things we see in our work that we don’t tell you, we endure working long hours, evenings, nights, weekends, holidays, short staffed, underpaid and very often with empty stomachs, full bladders and achy feet or backs. What I experienced on Friday, takes its toll on nurses over time and makes us question why we chose this profession. It is a huge contributor to burn out and job dissatisfaction. Why would I want one or both of my children to experience this throughout what will be a career that will span over forty years? Why am I putting up with this? Where is it written that just because we are care givers that we should have to tolerate physical and verbal abuse just because people are sick? But somehow, for some reason we continue. We try to shake it off as best we can. Sometimes we have a drink when we get home. We vacation. We pray, We exercise. We meditate. We engage in activities that we enjoy. We spend time with family and friends. We thank God everyday that we are healthy and do not have the diseases that we treat.
To my patients I say: I am your caregiver and your advocate. You are safe on my watch. I am a registered nurse. I hold a nursing license, a bachelor’s degree and a nationally recognized certification. You’ll never know the blood, sweat and tears I shed during college and throughout my career to become the skilled, knowledgeable and caring nurse that stands before you. The fact that you don’t know me as a person or as a nurse, doesn’t give you the right to tell me I don’t know what I’m doing. If you’d give me a chance before your judge me, you’ll see that I do know what I’m doing. Being sick and afraid doesn’t give you the right to verbally and physically abuse me. I know you are sick and afraid and I promise to give you my very best. Please treat me with the same kindness, you wish for in return. Please remember, like yourselves, I am a human being too.
One thought on “A Day in the life of a Nurse”
I’m so grateful to my friend Linda for introducing me to your blog. I’ve experienced compassion fatigue from both sides of the bed and I want to thank you for your awareness of the daily challenges you face, of your human reactions to them, and of the options you take for recovery and self care. I am a retired RN and I led a big, national nurse organization where compassion fatigue was on our agenda. Then, in January 2011 I was a pedestrian hit and run over by a drunk driver. My torso was crushed — 36 fractures, all ribs, sternum, flail chest, pelvis, crushed sacrum, crushed vertebrae, spinal cord injury, many complications including blood clots, autonomic dysreflexia, and MRSA pneumonia. I was in Shock Trauma for 2 months where I was on a ventilator for 5 weeks, and in a rehab hospital for 2 months. I came out in a wheelchair. It was quite a journey. Today I am well, happy, peaceful, active and walking! I continue to work on my physical, mental and spiritual recovery every day. I remember all of the aides, techs, housekeepers and even doctors as kind and helpful. And I remember that every RN assigned to me over those four months, those who really bore the greatest responsibility for my care, often showed me their exasperation, especially with my agitation. I was suffused with fear and never got used to the ventilator. My lungs were crushed, bruised, and filled with fluid (until week 5 when more drains were inserted). I was disoriented at times and unable to communicate my needs except by banging on the side-rails. I extubated myself once and was then tied down at night. I was probably every RNs worst nightmare as a patient. I knew, as it all was happening, how much work I required and that the nurses had too many other patients. I saw them making errors in sterile technique and medications because they were so rushed. I could tell that they were not getting the support from management to be at their best with every patient. At the same time, I was devastated that they didn’t know that I was a good person, a kind person, a loving person, a peaceful person, a resilient person. All they saw was a demanding, fearful, delirious person who they assumed wouldn’t remember me seeing them roll their eyes or sigh heavily as I banged on the side-rails. I was so devastated by this change in how my colleagues viewed me that I asked to be made a No Code. It would have helped if someone had said to me some of the things you wrote in your piece. It might have helped me to hear, “I see you. You are afraid. That’s understandable. I am your caregiver and your advocate. You are safe on my watch. I know you are sick and afraid and I promise to give you my very best. I am here for you. This is really hard for you. You are going to get to the other side of it. These are your vital signs. This is what the ventilator tells us. I’ll bring you more medicine to help your anxiety.” For RNs to be able to do this when they are feeling abused is a high, high bar. Are we preparing nurses well enough to accept without judgement patients and families in their time of extreme distress? To understand that they may not be seeing the real person? That they are seeing the essence of fear? Are employers doing enough to support nurses with proper staffing, coaching, training, time off, and fair compensation? I don’t think we are there yet. I’ll be interested in your further thoughts as you make your way through this demanding profession. Thank you for documenting what it’s like for you so clearly and beautifully. All the best to you and yours. Love & Light, Valerie
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