My name is not Catharine. My name is "Nurse!" Not "Nurse?" Or "Nurse." But "Nurse!" Sometimes "Nuuurrrrsssse!!!!" That is what I'm called by the patients (if they can talk), their families, the doctors, social workers, dietitians, respiratory therapists, chaplains, visitors, physical therapists, everybody calls me "Nurse!" I'd sooner be called c*nt, b*tch, f*ckface or wh*re because calling me "Nurse!" amounts to a Master calling a slave. And slave I am.
In my job I am not allowed to curse under my breath, disagree, look serious or speak my mind. I am not allowed to be anything less than warm, friendly and accommodating. Male nurses, of which there are many in critical care, are not held to the same standards. As long as they are knowledgeable and skillful, they are considered "good" nurses. Female nurses, no matter how knowledgeable and skillful, still have to do a lot of ass-kissing to be considered "good" nurses.
According to the hospital, nothing is more important than "customer service." Never mind that I am not selling anything, that I am working with patients, not "customers." I am servicing. Above all, I must service the whims and fancies of the patients (yes, people really do ask me to fluff their pillow), their families (an empty plastic pitcher is thrust in my face along with the command "ice!"), the doctors (no example needed), my manager, and to a lesser extent, my coworkers. In this age of consumer medicine, "servicing" has become more important than providing the actual nursing care for which I studied, was trained and practice according to the highest possible standards and latest research.
Despite the pretense of the "team" approach in our ICU, my opinion doesn't mean much. A few Attendings will ask if there are any "nursing issues," but not many. Nevertheless, because I want the best for my patients, I often "cover" for physicians. I say nothing when an intern presents my idea as his/her own during rounds. I order important labs and x-rays when the medical team "forgets." I spend an extraordinary amount of time explaining a patient's diagnosis, reviewing the plan of care and answering questions honestly and in a way that the family can understand, which often allows the time a physician spends with the family to be more efficient.
I have too many fingers to count the number of times in the last ten years a physician has thanked me for my efforts.
I had to laugh the day an intern was in the room with a patient who started to code (hadn't I been warning him for hours that this was going to happen?!) and the doctor desperately called out, "I need a nurse!" It wasn't about the tasks that needed to be done. This young fellow had no idea how to run a code. But that's how it is in a teaching hospital.
Nurses get no respect. It always hurts to see a patient's family, who has been rude and demanding and condescending to me for hours, bow and scrape and fall apart with gratitude when a doctor enters the room. Don't get me wrong. I have enormous respect for physicians. I am stunned by the intelligence, commitment, compassion and the huge amount of responsibility that doctors bring to the table. But a nurse is always, well, just a nurse. Somehow it is easy to forget that the person who keeps the patient clean, dry and comfortable, the person who makes sure that labs and other diagnostics are done, the person who administers the necessary medications and treatments, the person who manages the continuous dialysis, keeps an eye on the ventilator, collects and records the data, does the wound care, cleans up the shit, blood and vomit, educates and addresses the emotional needs of the patient/family, has the greatest risk of exposure, uses her knowledge and judgment to do exactly what needs to be done at exactly the right time, must stomp her feet in order to get the resident to listen when a problem is developing, in short, the person who keeps the patient alive minute by minute, is just a nurse. And when the time comes, it is the nurse who makes damn sure that the patient dies with as much comfort and dignity as possible.
Nursing is not highly valued as a profession. Nursing (especially critical care) demands a broad knowledge base, advanced technical skills and a great deal of judgment. It seems that we are suffering from a collective historical hangover from the days when nursing was unskilled "women's work." Plumbers make more money and nobody dies if they have a bad day. And I admit nurses are better off in the US than in most other countries. When my mother-in-law tells her friends in Serbia that I am a nurse, she might as well be telling them that I am a street sweeper. Let's face it: How many of you are hoping your kid will grow up to become a nurse?
In fact, with the exception of Halloween night in 1971, I never wanted to be a nurse. I was going to get my PhD in Philosophy. But then it hit me that I had a family to support and that changed everything.
As it turns out, becoming a nurse is one of the best decisions that I have ever made. I can't imagine any other job that would give me the same opportunity for meaningful, authentic human contact. I have provided comfort. I have eased suffering. I have protected the vulnerable. I have grieved with families. I have met needs that are real and immediate. I work tirelessly to keep people alive. I am a staunch patient advocate. I have seen many die but I have also saved a few lives. This work happens in a place much deeper than class, race, gender, sexuality, etc. Being a nurse has taught me more about being a human being than a PhD in Philosophy ever could.
So, yes, I am in many ways a slave. Many see nursing as nothing more than following physician orders (and be "caring" while you're at it!). I work in an ocean of blood, shit and tears that the average person just can't imagine. My work is hard (mentally, physically and emotionally) and in general, I do not recommend it. But at the end of my fourteen hour day, when I come home cursing and complaining, barely able to take another step, I know that I have done something meaningful, something real. And that, somehow, makes it worth it.
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Catharine, I DEMAND that you start your own fucking blog!!! NOW!!!!111!!1!1!1ELEBENTY!!111!
Posted by: Comrade PhysioProf | June 17, 2009 5:27 PM
Catherine!! You are an excellent writer. I second PhysioProf's demand.
Posted by: Arikia | June 17, 2009 6:22 PM
Great post!
I volunteer in a hospital, and I have immense respect for the nurses. I wouldn't be able to do your job.
Posted by: Kim | June 17, 2009 8:51 PM
Excellent post. Would there be any advantage (more respect, more pay?) to becoming a nurse practitioner?
Perhaps when the kids are off doing their own thing, you can take that philosophy degree, just for fun.
Posted by: bill | June 17, 2009 9:32 PM
Great post! I agree with CPP. I'd read your blog if you had one.
Posted by: JThompson | June 17, 2009 9:58 PM
Catherine,
Since you work in ICU, are you assigned to a maximum of two patients at a time, and one if it's a high-acuity patient?
You mention that you frequently work 14-hour shifts. Does your hospital abide by overtime laws and regulations, and pay you for missed meal and rest breaks, if applicable in your state?
Does your unit have a full complement of support staff, including nurses' aides & secretaries, so that you can focus on direct patient care?
As a staff nurse, do you feel that you and your colleagues have meaningful input into hospital policies affecting patients and nurses?
Do you have a defined-benefit pension, or a risky 401(k)-style retirement plan?
Your professional ethics seem to compel you to articulate the degradation inherent in treating patients as "customers." Have you ever thought that bedside nurses are particularly well-situated to lead the health care reform movement in this country?
Posted by: JN | June 17, 2009 10:01 PM
@JN: most emphatically don't want to speak for Catharine here, but I've seen what happens to bedside nurses who try to reform healthcare here in Oregon. They get fired for trumped-up reasons and then their union does its best for them but the legal wrangling goes on so long they have to give in or find other jobs in order to keep eating.
I don't think it fair to blame people at the *bottom* of the power structure for not reshaping it, which -- though you may not have meant it that way -- is how your comment comes across to me.
Posted by: bill | June 17, 2009 10:06 PM
Draga Kato,
suze su mi pošle... I haven't read recently something that moved me more. For both as provider and one on receiving end, I can hardly say how much I stand behind each word of yours! So many times, in Serbia, I respected nurse more than a physician. They were on the spot, each time right, and MDs were not once wrong. Dangerously wrong. I recall when I gave birth to Djordje, in Visegradska, during those horrible times in 1993, there was ONE nurse on the whole 4th floor with more than 100 women who gave birth. Just to run from one side of the building to another was tiring enough. Just to check in every fresh mother. As Djordje was 5kg, I lost a lot of blood and I was one of those cases that needed to be monitored. This Little Girl, A Nurse, has THIS BIG heart, just as you do, and I can feel it. At the end, you are completely right, what matters you have. The Look in the eyes of those you care about, occasional Look of gratitude of those family members who do understand. And Love of all the rest of us who know what you do. Those who don't get it - they don't f... matter.
My bow goes to you, Lady
Sincerely
Tanja
Posted by: Tanja Sova | June 17, 2009 10:07 PM
I don't know if it's because of the nurses and doctors I've had, the nurses taking care of loved ones, or the fact that my aunt is a nurse, but I've always had a great deal of respect for them. When one wrapped me up in warm blankets before my first surgery, I felt more grateful than I've felt in a long, long time. When one IVed me effortlessly where many have trouble (my veins are notoriously stubborn!), I admired her skill quite a bit.
But even in my little experience in hospitals and such, I've seen nurses get some pretty shitty treatment, and it really disgusts me each time. All of my nurses have always been extremely warming. Well. Okay. The female ones. The males were noticeably less so, in my opinion. But that's probably in large part due to the difference in standards you mentioned. And I'm really disappointed in what they get in return sometimes. So it's nice to read it from the perspective of a nurse.
Posted by: Josie | June 17, 2009 11:10 PM
Dear Catharine, such a lot of comments and all of them sent with great respect both for your post and your work is the best birthday present to you. I quite agree that you deserve all the respect. I also agree that you should start your own blog.Best wishes from Serbija , where we have serious problems with nurses but of a different kind.Love yours Rea
Posted by: Rea | June 18, 2009 1:11 AM
I loved this article. But then... what do you want to achieve with it? I am pretty sure that the audience of this blog does not need any convincing of the worth and professionalism of nurses. If you want to change people's attitude and behaviour this should have been posted somewhere else, somewhere where it would receive a wider audience.
And I do think that it would be a great idea to find that wider audience. If only every nurse would be as articulate as this...
Posted by: Michael Keizer | June 18, 2009 8:04 AM
As one who did patient care for over a decade before becoming a medical salesman, I'd like to offer these recommendations to those patient caregivers who are perhaps new to their profession:
1. Do not let those in the pharmaceutical or medical device industries, for example, interfere with or take priority over patient care.
2. Do not let the industry befriend your staff to gain access to doctors that work with them who are restoring the health of their patients.
3. Do have nurses only accept drug samples from drug reps. No literature of any kind from them. Likely, any clinical information the drug rep may have regarding the drug samples he or she may leave you is inaccurate.
4. Do let those you work with know they have a right to refuse interaction with the medical industries in their practice.
5. Do not answer questions from drug reps about what doctors prefer prescribing for their patients as it relates to their promoted products, or anything else about the health care providers at your location, for that matter.
6. Do not accept any promotional material unless it is truly beneficial for their patients, without branding on the material offered to members who work at your clinic or medical institution.
7. Do let the nurses know that drug reps. are overall not in their clinical setting to facilitate patient care, but to rather increase the volume of what they many be promoting, as this is the etiology for their interaction with you.
8. Do let others who you work wth that, if asked by medical representatives to have a disease screening day of some sort at your facility, or has invitations for such a screening for you or others to attend, consider refusing this request. Often, the screenings are conducted by front groups to expand the diagnostic boundaries of a particular disease state.
9. Do make others you may work with aware, or reiterate to them, that generic drugs are preferred over branded drugs for many reasons, including cost and experience with the medication while providing the safety and efficacy your patients need. Such drugs are listed in what is called an Orange Book.
10. Do let the nurse know that drug reps have in their possession the prescribing or buying habits of health care providers, and will tailor their interaction with them and the prescribers based on this data.
11. Do let others you may work with know that the drug reps are, overall, decent and friendly people who are just doing what they are instructed to do by their employer, and they should be aware of what they may be doing could be detrimental to the health of their patients, if such situations develop.
12. Do let those you may work with know that medical representatives who may be in your patient treatment area can question doctors about what they may choose to prescribe a patient. Yet such representatives should be aware that their time at your patient treatment area is limited.
13. Do let others you may work with know that there are doctors who receive inducements, incentives, rebates, and remuneration from particular drug reps. These gifts that are actually bribes are largely based on the prescriber's affinity for the drug. rep's promoted products or the volume of prescriptions a doctor writes compared with other health care providers. The potential consequences of accepting such bribes which the industry calls many things, including 'gifts', could have on the health of patients and the choices of treatment for them. Such bribing may cloud the judgment of the health care providers who receive such gifts..
14. Let others you may work with know that pharmaceuticals are not the answer to all symptoms or medical conditions. This is of particular importance when it comes to the issue of utilizing psychotropic drugs and antibiotics, as drugs are very over-utilized in the United States.
15. Let others who may work with you know that they should make patient care paramount when seeing patients, and should not let the industry coerce them into thinking otherwise. In other words, their idealism and passion straight out of school should be maintained, however difficult this may be at times. As a patient caregiver, you may get overwhelmed at times.
16. Let others you may work with know that, in the U.S., medical reps. have little training, education, or clinical knowledge relevant to what they may be promoting, however may have charming personalities and appear to possess quality genetic stock. What they may share with you about their promoted drugs is likely embellished or fabricated, if not fully understood by the medical representative.
17. Let others you may work with know that whatever is done for or with patients should be entirely for their benefit, and not for the benefit of a drug company or a health care provider, if such a situation develops or are noticed.
18. Speaking from the perception of the situation in the U.S., there is a shortage of nurses, and the demands on them are cumbersome and exhausting. Remind the nurses that this should not affect the treatment and care they give their patients, as difficult as this may be for the nurses. The pharma industry only amplifies this situation in various ways at certain times and locations. To say again, do not allow others to interfere with patient care.
19. Let others you may work with know that their vocations are noble and needed, and what they do for others most choose not to consider, such as drug reps., for example.
20. "Nursing would be a dream job if there were no doctors." --- Imo Philips
Dan Abshear
Posted by: Dan | June 18, 2009 10:04 AM
JN: We are allowed one 30 minute break, if we are lucky, and that time is automatically deducted from our pay. We have no nursing assistants. We have no union (still a bad word in the South - a nurse who tried to start one got fired for "unrelated" reasons). Nursing does not have much impact on hospital policy, although the hospital would like to pretend otherwise. An example of how the wheels turn at my hospital: We are expected to complete an employee satisfaction survey (great, it looks like our input matters), however, if the hospital scores low on this survey, we (all of us) don't get a bonus. None of us will get a raise for the next fiscal year. Unfortunately, I don't think nurses are in a position to lead health care reform. Most of us are too busy trying to keep our families fed, our collective heads above water, many of us have to work a good deal of overtime. And, yes, we do get paid appropriately for overtime. We voted for Obama. That's about the best we can do right now.
Dan: Nurses are pretty savvy when it comes to drugs/drug reps/product reps. Thanks for the tips.
Everybody: Thank you so much for all of your comments. The great response means a lot to me.
Posted by: Catharine | June 18, 2009 10:57 AM
Thank you so much for your post. Your honesty is refreshing, and much needed. As someone who is shortly facing a hospital stay, while I hope I'd never be a demanding patient, I will try even harder to learn my nurses' names and show them the respect you all so richly deserve.
Posted by: Molly | June 18, 2009 12:22 PM
Molly: Don't be afraid to ask for what you need! The vast majority of nurses WANT to take good care of patients and will do whatever it takes to make you comfortable. I hope you have a speedy and easy recovery!
Posted by: Catharine | June 18, 2009 12:29 PM
Catharine,
You may want to look into this organization: CNA/NNOC
Posted by: JN | June 18, 2009 2:09 PM
Fantastic post. And if you do start your own blog, I'll read it avidly.
Posted by: MissPrism | June 18, 2009 2:19 PM
I am extremely moved and touched by this post and frankly, don't really know what to say, but felt compelled to leave a comment.
"But at the end of my fourteen hour day, when I come home cursing and complaining, barely able to take another step, I know that I have done something meaningful, something real. And that, somehow, makes it worth it".
Catharine, with and without my patient advocacy "hat" on, I salute you x 100.
Posted by: Graham Steel | June 18, 2009 2:47 PM
And no patient is ever made any more appreciative by the fact that nurses are the ones who have to say things like, "I know you're in a lot of pain, but you need to get up and walk now." Thank you for writing this, Catharine.
Posted by: Stephanie Z | June 18, 2009 4:35 PM
That's the way it is with pain -- all kinds of pain -- you have to grit your teeth and go through it (there's no way around it).
Posted by: Catharine | June 18, 2009 4:54 PM
Foremost, I am wholeheartedly with Physio! You know I think you're a terrific writer! Let's see a nursing-and-other-musings blog! I expect you'll be tremendously popular :)
Second, having spent a good deal of the early months of 2009 among nurses, doctors, and in and out of hospitals, I've encountered a large spectrum of health care professionals and can report with certainty that nurses like you are a blessing to all of us.
If only every one of your patients knew how lucky they were...
Posted by: Sheril R. Kirshenbaum | June 19, 2009 7:29 PM
During a recent hospitalization I learned a lot about your work. I had no idea of the physical and mental agility and the extraordinary diplomatic skills you had to master.
For eleven days, nurses accomplished what needed to be done for me. I saw nurses cover for doctors, pick up the slack when their peers and aides were overwhelmed or inept or simply showed up late or not at all. For example, a nurse not only managed to push through an order overlooked by a colleague but also stayed late to wheel me down to x-ray in the middle of the night by herself so that the next step in my care would not be delayed -- and so that neither her colleague nor my doctor lost face.
I was touched more than I can say by how hard nurses work and how seldom you receive anything near the expressions of gratitude that you should. So I wanted to say here that I thank you all. I truly felt ministered to by angels.
Posted by: Anita | June 20, 2009 1:24 AM
Well written and moving!
Posted by: Toaster | June 21, 2009 3:47 PM
I have a deep and abiding respect for each and every one of the nurses that have seen me through my hospital stays. The doctors have all been OK, but the nurses have mostly been awesome. There have been a few that have been jackasses, but mostly, they've been awesome.
Thankless job, that usually doesn't pay enough (although I think it's not too bad here!), that I couldn't do for love or money!
Posted by: CanadianChick | June 21, 2009 5:32 PM
Hi Catherine:
It's a shame your residents don't appreciate you more. I know as a resident, I have been counselled by everyone to listen to everything the nurses say. Much of my learning, both in the teaching centres and in the community, has been with great nurses.
I try to know everyone's name, and sometimes I fail (they switch shifts, and I am only around for a month or two at a time). If the nurses don't trust me, there's no hope for my rotation as a resident, nor my future as a physician.
Posted by: red rabbit | June 22, 2009 11:02 AM
PLEASE start your own blog - healthcare needs this voice to be heard loud and clear....
Posted by: Erika | June 22, 2009 2:52 PM
Start your own blog, you've got a fantastic writing voice! Great post.
Posted by: NurseExec | June 26, 2009 9:20 AM
Great post! Love it. Everything you said is so true.
Posted by: Nicole of Raspberry Stethoscope | June 28, 2009 6:42 AM
Catherine,
Your post has made me so sad. This is not nursing everywhere. I love my job as a critical care nurse, and my experience differs radically from yours. Nursing has many problems, but you seem to be in a rather toxic work environment where they are magnified x50. This is a well written post, and you have a strong voice. I hope you get out of this environment and keep writing about your experiences. Good Luck!
Posted by: L.B. | June 28, 2009 8:14 PM
Love the post & the insight of your work you've shared, Catherine! What about the blog so many have suggested - are you thinking about writing one? I sure would follow you as well... However, if L.B. is right & you question your work environment, do know there are many opportunities out there for you! All the best! Cheers, Julie
Posted by: Julie Davis | June 29, 2009 11:11 AM
umm...i don't get this website??? :/
Posted by: Lauren | July 2, 2009 7:10 AM
Although I've been fortunate enough to avoid hospital stays thus far, I'll remember this post if and when I find myself dealing with a nurse... and I'll remember to be polite, and appreciative, and to ask his/her name.
Beautifully written. Thank you for sharing.
Posted by: Kat | July 2, 2009 10:12 AM
Thanks for the moving post and for being one of all the amazing nurses out there.
Posted by: Jeff | July 6, 2009 5:58 PM
Thanks for the moving post and being one of the amazing nurses out there.
Posted by: Jeff | July 6, 2009 6:01 PM
I am a student nurse currently practicing in a well known hospital in Brisbane, Australia and have at times questioned myself if this is truly the profession I want to lead. Reading your post have given me the inspiration and the answer.
Posted by: Katrina | September 4, 2009 5:52 PM
Hi, my sister is a nurse, and i agree that nursing is not highly valued as a profession today. Though it requires much knowledge and concentration.
Posted by: Torrent Search | January 14, 2010 4:20 AM