Something Unexpected

I’ve been a licensed Registered Nurse for 7 months now and so far very little has been what I expected. For starters I work in one of the two areas of nursing that I thought I would never venture into. The first is pediatrics and the second was long-term geriatric care.

I, like most new graduate nurses, assumed I would be working in a hospital. Probably a med/surg floor to start and possibly (hopefully) ending up in critical care. Instead I ended up working in a nursing home. It isn’t where I pictured myself working – and in many ways it is the polar opposite of what you spend the majority of your time learning in nursing school.

The nursing home clinical rotation is usually the first semester rotation in most nursing programs. It’s the “easy” rotation because you don’t administer medications, you don’t start IVs, you don’t do a lot of the modern day nursing skills that you will eventually be learning to do.  In the nursing home rotation you do bed baths, linen changes, and you talk to people. The problem is that they usually pair you up with the residents who are a bit further from death.  The ones who are a bit more self-sufficient, the ones who are aren’t late stage dementia, the ones who aren’t likely to cuss you out, spit their food/meds on you, or hit/kick/bite you. The ones who aren’t as likely to die while you’re in clinicals. So you, the fresh faced, idealistic, hope-filled nursing student leave the nursing home thinking, “Wow! That was easy. That was too easy! I want to do something important.”

The reality is that working in a nursing home is harder that you’re led to believe by a quick and easy first semester clinical rotation. It’s much more emotionally draining than that first semester shows you. When you’re paired up with an elderly person who is still fairly capable of having a conversation you don’t see what Alzheimer’s dementia really does to a person, or how hard it can be to care for someone with that disease. When you spend your days talking to and taking care of people who are still relatively healthy it doesn’t prepare you for the emotional toil of caring for someone who is actively dying.

And because the first semester rotation is the only time you’re going to set foot in a long-term care setting you’re not going to get that experience or perspective.

Nursing home and hospice care is the antithesis of everything you learn in nursing school.  Oh sure you talk a bit about death and dying (particularly the 5 stages of grief and how to do post mortem care after the patient has died) in school.  But most of what you learn is focused on how to care for people who are likely to get better. How to “save lives.” The focus is on diseases that you can actually do something about.

Combine that educational focus with the modern day expectation of nurses created by such unrealistic shows as HawthoRNe, Grey’s Anatomy, Nurse Jackie, etc. and you end up with a picture of nursing that is focused solely on healing people and saving lives.

So imagine my surprise when my two most gratifying moments as a nurse – the two experiences that actually made me think that nursing school was a good idea – were with residents who passed away. I’m becoming familiar with death. I work in a nursing home, it’s hard not to. These two residents are not the only residents I’ve worked with who have died, and they certainly won’t be the last. But both of these residents were hospice patients and my sole role in their end-of-life journeys was to make them as comfortable as I could. Essentially I was to help them to die peacefully.

My role for their families was a bit more complicated. It was to help them be comfortable with what was happening. To explain that process of dying, to explain how what I was doing would help, to educate them on what to expect as the end drew nearer, and ultimately to offer them comfort when their loved one did die.

It’s not a role I pictured myself in. It’s not a job I imagined doing. It certainly isn’t something I thought would be rewarding. But somehow it was. Not in the “it made me feel great!” kind of way. But in the, “Wow, I did something that actually made a difference for someone” kind of way.

All too often we tend to think that making a difference as nurse means helping to heal someone so that they can go home and keep on living. I am as guilty as the next person of falling into that trap. It was very unexpected for me to realize that helping someone die with their human dignity in tact (not as easy task as so much of the practice of medicine strips our patients of their dignity and often ignores their humanity) matters and it makes a difference.

I don’t know how much of a difference it makes to the person who has died because I don’t pretend to know what happens at the time of death or after death (if there is anything after death), and most people who are at the very end of their lives aren’t going to be able to tell you if what you’re doing matters to them or not. But I know that what I did for my residents in the last hours of their lives made a difference to their families.

It was something unexpected to realize that there is so much more to nursing that just making people feel better. I’m still not sure that this is the field I will spend the rest of my nursing career in, but I’ve learned to respect the job that long-term care and hospice workers do. It matters. It matters a lot.

 

A Quick Reply Isn’t Enough – To “Snobby Nurse”

My little tiny corner of the internet is a humble and not very visited place. Or at least it wasn’t until I penned a vent/rant about a chance encounter with another nurse at a local Starbucks. That one post has, in less than two days, had just shy of 1,000 views. That’s pretty amazing to me, since my previous best post was 140 views.  I’m told that it really made the rounds on Facebook. I didn’t really know how far it had traveled and how widely it had spread because I was, as night shift nurses are so fond of doing, sleeping during the day yesterday and working all last night.

In a moment that proves just how small the internet manages to make our world I got a response to my blog post from the nurse with whom I had the encounter. At first I read her words and I thought of just posting a quick reply to her comment … but then I realized there is no way conceivable in which that is an appropriate response to her kind words. So instead I’m going to re-post her comment here along with my reply to her. I can only hope that this garners as much response as my original vent, because it should. It was one of those moments that makes you stop and realize that there is a glimmer of hope in humanity and that “Snobby Nurse” is really a class act.

Her comment:

I am so sorry that you obtained so much from our brief encounter. I’m sorry we didn’t get to go through a proper introduction. I, too was a Lpn for 10 years before getting said RN degree. Maybe I came off rude & for that I am sorry. I did not mean anything as you took it. I was running late for my nightshift & I just cut the conversation short w/out thinking how it affected you. I am not a snob, just started the nightshift & had barely had any sleep. I have also worked in long term care w/some amazing CNAs & LPNs, I have total respect for all they do. I figured out that long term care was not for me. I’m sorry, I didn’t mean to offend you..in my experience in long term care I never saw a RN doing any type of “dirty work” (just goes to show, I too have worked w/some “snobby” RNs who thought they were too good for that) I have cleaned & changed people from the nursing home, placed catheters, changed beds, & held buckets while people vomit. I did not mean to come across like I am disgusted by those things, just the fact that I don’t do it every day as in a long term setting. It is for some people, I tried it…not for me. I admire you & by no means meant any offense to you. When I saw this post shared on a friends wall & read it I was mortified. I am truly sorry. Shall we meet again I will apologize in person & maybe we can call truce. Looking back on conversation, I was short & came across wrong. Truly sorry!

Here is my reply:

Dear Fellow Tired Nurse (formerly “Snobby Nurse”)

I would like to accept your apology, but only if you in turn will accept mine.

I suppose I am a bit overly sensitive on the subject of my job. As I mentioned in my original post, I am a bit burnt out – in fact I think I am a lot burnt out. To the point of questioning why I do what I do and if I made a mistake by getting a degree in nursing as opposed to Art History or Accounting. I’ve been told by some well-meaning friends that now that I’ve been in the long-term care setting as a Registered Nurse I may, in fact, be stuck in long-term care for … well … the long-term. Basically that once you’re a long-term care nurse (particularly as a RN) you’re pretty much stuck in long-term care because hospital hiring managers and DONs won’t take you seriously. Since I’m hoping to work in several different fields of nursing over the course of my career, this is disheartening (but seemingly accurate) news. My frustration over that isn’t usually far from the surface – in large part because questions about my career choices aren’t far from the surface.

As a result of those words from my friends and my own doubts I was more than a bit thin-skinned to your comments. I can also say without a shadow of doubt that my own long night shifts, sleepless days, and chronic sleep deprivation certainly don’t combine to make me any less sensitive, or apparently objective.

So for my part in the misunderstanding that was our brief encounter, I am very sorry.

I would like to thank you for taking the time to respond to me, and for doing it so kindly. I realize that many would have taken my words and tone as an invitation to be as snarky as I was. That you didn’t respond with anger or sarcasm speaks volumes about you. I misjudged you, and for that I also apologize.

I hope that by sharing your comment and my response in its own blog post that I can underscore how sorry I am for my knee-jerk reaction. But also I hope in some small way to repair your “reputation” (even if only you know who you are).

Should we ever have the opportunity to meet again, I would very much like to buy your coffee (with as many espresso shots as you need).

Wishing you all of the best – with my deepest thanks and most sincere apologies,

Carole

 

Dear Snobby Nurse

Just a note to everyone who has read and shared, and those who are still reading and sharing this blog – Please check out the follow up at https://crazylifestartsnow.wordpress.com/2014/01/15/a-quick-reply-isnt-enough-to-snobby-nurse/.  I think it is well worth seeing what an amazing thing the Internet can be by making the world a little smaller!

Warmest wishes,

Carole

Last night I was at Starbucks with my daughter. In line ahead of us was a woman in scrubs getting a Hazelnut Macchiato with a triple shot of espresso.  Oh yeah – I’ve been there. Loading up on caffeine before heading in for a 12-hour night shift. The barista made a comment about the amount of caffeine and I mentioned that after awhile you become habituated to the caffeine, and talked about how I can drink 4 Monsters during my shift and still come home and go to bed. The woman, hereafter called Snobby Nurse said that she hasn’t reached that point yet and began talking about how she never sleeps well during the day.  We commiserated for a brief moment about how hard night shifts are. The conversation when downhill from there. It went something like this.

Me: Yeah. It’s a glamorous life. Changing bedpans, emptying catheter bags, and wiping people’s butts.

SN: Oh I don’t have to do any of that kind of thing. I’m an ER nurse. We stabilize them and then move them out.

Me: Yeah, I can see that. I’m in long-term care so I do a bit more of the “dirty work.”

SN: <speaking disdainfully> Oh! Well, that’s why I went to the extra school to be a RN.

At this point in the conversation I was flabbergasted. She just made a huge, and erroneous, assumption about me. Not only that but her tone was dripping with disdain and a snobbery that I knew existed toward long-term care nurses, but hadn’t actually seen in action. What do I say? Do I respond in snarky kind? Do I ignore her? Do I point out that I, too, am a RN? Do I point out that even if I was “just” an LPN it doesn’t make any difference, we’re all supposed to be in the same business – caring for other human beings?

I settled on simply saying, “Oh. I am a Registered Nurse,” and let her walk away.

But I was, and still am, pissed off by her comments and her attitude.

Here’s what I would like to have been able to say to her – and to all of the RN’s out there who work in hospitals and think that that makes them a better nurse or a better person.

Dear Snobby Nurse,

You’re not that freaking special. We’re all nurses. RN doesn’t stand for “Real Nurse” and LPN doesn’t stand for “Let’s Play Nurse.” We all care for our patients to the best of our ability. We all work long hours for not nearly enough pay. We all break our backs day in and day out. We all feel stress. We all suffer from burnout much faster than people in non-healthcare fields. We’re in this together.

The fact that you are a RN doesn’t make you more special. It doesn’t make you more important. It doesn’t make you different.

That you assumed that I am not a Registered Nurse because I work in a long-term care setting is presumptuous and ignorant. But let me just say this – even if I was a Licensed Practical Nurse (which clearly you see as inferior beings), so what? Does that give you the right to be obnoxious to a total stranger? Let me just tell you, Honey, I work with some LPNs who have forgotten more about nursing than I will ever be able to learn. I am proud to work with LPNs who are some of the finest nurses you will ever meet. In fact, I work with LPNs whom I would explicitly trust to care for any member of my family, while I wouldn’t let you “a RN” treat my dead dog.

If you assumed that I am a Certified Nursing Assistant (CNA) because I said I deal with bedpans and catheter bags and that’s why you were so rude … well shame on you. Because again, I work with some CNAs who are absolutely amazing at offering patient/resident care.  They aren’t called skilled assistive staff for no reason.  These women and men have skills – and I couldn’t do my job were it not for them tirelessly doing their jobs.  Maybe if you climbed down out of the ivory tower you clearly think your ER is housed in and worked side by side with the people who care for their patients for more than an hour or so you’d realize just how invaluable the contribution they make is.  But no, that would require you to get your hands dirty, and perhaps get some shit on your pristine scrubs. It would also require you to touch base with basic common courtesy and to pull your apparently overly educated head out of your rectum.

Long-term care, rehabilitative care, home health, and outpatient services are the jobs of nursing’s future. More and more medical services are going to be “out sourced” to settings other than hospital settings.  As hospital stays become shorter and insurance companies are willing to pay for less in those hospitals nursing is going to be changing. As our population reaches that tipping point where there are more elderly people than there are non-elderly people long-term care will become an even bigger aspect to healthcare and more and more nurses will be needed in those settings. So acting like the only “Real Nurses” are those who work in hospitals is going to severely limit who you see as a nurse.

I am a long-term care nurse.  My job isn’t going to become a TV show any time soon.  It’s not nearly as glamorous as pulling Fruit Loops out of a toddler’s nostril, or explaining to a 40-something guy that the blood in his stool is from hemorrhoids and he should see his doctor on Monday.  It certainly isn’t as life changing as the woman who has had the flu for 4 days and suddenly decides the day her doctor’s office is closed that she just has to see someone right now about it.  And it certainly isn’t as important as dealing with the drug seeker who is faking back pain to score some Oxy or some Dilaudid. Oh sure, I know that you do see real emergencies in the ER and I know that sometimes you get to save a life in that TV Drama worthy moment.  But I also know that a lot of ER shifts are chock full of just dealing with stupid stuff that people do that really isn’t an emergency and has no place in the ER.

Make no mistake about it, though, glamorous or not what I do is just as important as what you do.  As the old saying goes, “It’s a dirty job, but somebody has to do it.”

I spend my 12-hour shifts taking care of people who are never going to get better. I spend my shifts getting to know, and caring for and about people who I know are going to die. 90% or more of my residents are never going to “go home.” In fact, I will probably be present when many of them pass away. I spend my working hours trying to make them comfortable, make them smile, ease their pain, hold their hands through their fears, and often times I also comfort their families.

My job is physically demanding, intellectually challenging, and emotionally draining.  Just like yours.  The biggest difference is that I go in to work every day knowing that I am not ever going to see a happy ending.  Oh sure, we have a rehabilitation wing and some of those people will get to go home after they’ve recovered from surgery or had physical therapy. But those aren’t the majority of our residents. And even all too often those residents who do come home come back to stay with us in long-term care.

I’m sorry that you think that your title of RN means that you don’t have to get your hands dirty changing bed pans, changing catheter bags, wiping up vomit, or any of the dozens of less-than-fun things we often do. I don’t have to do too much of that either – because we’ve got great CNAs where I work and they do most of that, but I’m not above pitching in and getting dirty when it is needed. That you somehow think that you don’t have to, or shouldn’t have to, because you went the “extra mile” to get your RN just tells me that you missed some important lessons in nursing school …and you sure as hell didn’t pay any attention to the Nightingale Pledge at your pinning ceremony.

I do want to thank you, though. I was, as we all do, reaching a point where I felt burnt out. I was really starting to wonder if I wasted those years in college and all that tuition. I was starting to wonder if what I did makes a difference.

You were condescending and rude to me – and for that I thank you. Your rudeness, your condescension, your attitude of superiority made me think about who I am and what I do for a living – and you know what? What I do matters just as much as what you do. What I do makes a difference for the people I help.

I AM a nurse. I AM a Registered Nurse. I AM every bit as good as you. No, scratch that. I AM better than you because I don’t walk around thinking that I am better than anyone else – and even if I did … I have the class not to say it to them.

You? You’re just another rude broad at Starbucks and if I am ever unfortunate enough to land in your ER you can bet your last dollar that I won’t let you treat me or mine.

Sincerely,

Just Another RN