When you think about nursing, what do you see? I would bet that you see the quintessential nurse in scrubs coming to see you in your hospital bed, scanning your bracelet, running through your name and birth date, and giving you pills while asking you if you need anything, then rushing to the other side of the room or out the door to see his/her next patient.
Am I right?
Don’t feel bad, that’s the reality of hospital nursing. A nurse usually has anywhere from 5-7 patients of varying acuities at a time. Not only that, but most floors are understaffed in both nurses aides and nurses, which makes a regular day on a hospital floor even more hectic for everyone involved. Not only that, but the acuity of patient’s has increased ten-fold. Patients now have multiple co-morbidities, dozens of medications, IVs, PICC lines, central lines, wounds, mental health issues, etc. On top of all this, most patients think that a nurse is there to serve them snacks and drinks while being cheery and focusing solely on them at all times. No one truly realizes the stress, the pace, and the heartbreak of a nurses job.
My last and only hospital nursing job was at a small-ish hospital in Upstate New York. I could reflect and say that we were pretty lucky – during day shift at least. We would have 5 patients (6 at most) daily…with hopefully two nurses aides. In a regular day, if I am lucky, I might have one walkie talkie patient (someone who is able to get around and do things independently), a frequent flyer or two, and either 2 or 3 more patient’s who had undergone some sort of surgery. Now that might not phase those who don’t work in the field. “Oh, it doesn’t sound so bad! Why would anyone complain?” Well, let’s see…I’ll outline some of my most memorable patients as best I can…these are people I had frequently. Then I might outline an entire day from memory, if I have time. If not, I’ll follow up this post with another.
Let’s get on with it, shall we?
Patient A: mid-50’s, overweight male. This patient had had several flap surgeries on his buttocks due to pressure ulcers. Simple, right? No way. Not only was this patient paraplegic, he also had a right above the knee amputation due to his uncontrolled diabetes. He had a Hoyer lift in his room, which he never wanted to use. He was on chronic pain medications and would demand that they be given in the exact way and time that he wanted. If it wasn’t given at the EXACT time, there would be hell to pay. His glucose constantly ran in the high 300s and would refuse his insulin each time he was scheduled for them. Not only that, but he decided that he would be completely non-compliant with his diet. Every day, he would ask for two hamburgers, 2 puddings, and 2 whole milks. And the hospital kitchen staff would comply with his request or else he wouldn’t eat… or worse, throw a tantrum. Yes, that’s right, throw a tantrum. A 50-something year old man. A tantrum. He would yell, scream, grab his call bell and try to hit the nurses, grab milk cartons, spoons, plates and hurl them at anyone who upset him. On some strange occasions, he would acquire a “baby” voice and start calling several nurses “mommy” and revert to a child-like state. On top of all this, he was MRSA positive, which meant every time we would be called into his room, we had to gown and glove.
Patient B: 50-ish woman who was really a man. This was an interesting one due to the patient being very adamant that only certain nurses see her. I understand that, don’t get me wrong. She was a female with male parts – a penis and scrotum to be precise. She would tell people that she didn’t need to get out of bed to urinate because she could “position” herself over a urinal and urinate that way. Well, anyway, she would come in every month or so and we would all dread being chosen. I was chosen more often than not by her…but she had the worst attitude with everyone. I hadn’t had this patient for a while when I heard that she accused a nurse (one of my co-workers and friends) of not giving her pain medication when it was clearly documented in our electronic medical record. Well, much to my surprise – although I probably shouldn’t have been too surprised – she accused me of the same thing. I still don’t know what her angle was to say these things, but it didn’t get any of us nurses in trouble because everyone was aware of her.
Patient C: A patient who was paraplegic, in his 30s. “Fired” me as his nurse because I misunderstood what he wanted – instead of placing a bottle of lemonade in the water pitcher full of ice, I poured his lemonade into the water pitcher full of ice! How dare I? His exact request was, “Take this pitcher, fill it with ice, and then put this lemonade in the ice.” Apparently to him, this was a clear request. I don’t know, you guys tell me, was I deserving of being called an “ignorant nurse” for doing as he asked?
Patient D: This one is more about the patient by the door instead of the window, however you must understand what was going on with the patient at the window to see why I was so annoyed with the patient near the door. Patient at the window was mentally handicapped, unable to even transfer himself from bed to wheelchair. Because of this, we had to use a Hoyer lift any time he would need to be transferred. Well, this patient was finally being discharged. Unfortunately, he had just soiled himself and had to be cleaned and dressed prior to being transferred to his wheelchair. So, even though his group home caregiver was with him, she did absolutely nothing. Well, my aide and I clean him up and get him dressed. Put him on the Hoyer and transfer him to his chair. What happens? He soils himself again. Back into the bed he goes with the help of the Hoyer lift. The process starts all over. Now remember, please, that this space can’t be more than 10 feet, if that. We have 3 people in the room, not including the patient. It is hot, it is small, it is claustrophobic. With the machine in the room, it’s nearly impossible to maneuver. Well, finally, an hour later, we are all done and the patient is being wheeled out of the room. As I walk past the door side patient, he says very arrogantly, “I asked for my pain medication an hour ago.” Now, don’t get me wrong, I don’t play with anyone’s pain medications – I am very aware that people need their drugs for comfort. HOWEVER, you just heard my aide and I struggle for an hour with this other patient; I’ve had not one minute to recuperate, and you are going to be arrogant about it? Please, tell me I’m wrong.
These are just a TINY TINY portion of the patient’s I’ve encountered. I have dozens, if not hundreds, more. Add to it minimal breaks (30 minute lunch for a 12-hour shift with two 15-minute breaks), nurse managers who do nothing to help but constantly criticize and assistant nurse managers who couldn’t bear to stand up to help for a second and you have only a small idea of what hospital nursing is about. The beauty of hospital nursing is usually your co-workers, who understand you, cheer you on, and hopefully help you if they aren’t swamped – which is a rarity.