Things You Learn Quite Quickly as a Nurse
In nursing school they’re very, very busy trying to cram inordinate amounts of knowledge into your brain in a relatively short period of time. By busy, I mean sometimes six-hour lectures with few breaks. Plus lab time, plus clinicals, plus whatever other gen ed requirements you have, plus work, plus maybe sleep if you happen to have an hour or two with nothing better to do. It should go without saying that there are some things they just don’t have time for or don’t get around to teaching you.
Even if they think they’ve covered it all, there will be new and emerging diseases, drugs, dysfunctions, and scenarios that can and will happen. These stories are probably based on real things that have happened but I can neither confirm nor deny any of the facts.
1. Most of your new coworkers are going to be passive-aggressive as fuck.
They briefly cover horizontal hostility in nursing school. What they don’t tell you is that the majority of people are straight up passive aggressive. This culture is all but encouraged by hospital admins. Why? Patient satisfaction scores.
You are constantly told that a nurse's uniform isn't complete without a smile and to leave any personal problems at home. You are to be a perfect automaton and never be sick or tired. You are never to tell your patients that you might be tired. Ever. For years, you were encouraged to never admit a mistake to a patient. This false persona that's encouraged leads to people reacting to stress the only way possible without showing it in front of patients: petty-ass back biting, the blame game, and subtle over-arching hate towards their colleagues.
Nurse A might have a sick kid at home and a dickhead husband, but she’s not supposed to mention that at work where a patient might hear her. So she grits her teeth and focuses on the fact that Nurse B is always happy. Always. Just got married, young, pretty, seems to know it all. So she keeps making snide remarks about Nurse B all the time. Maybe she gives Nurse B the toughest assignments. She might seem to relish in Nurse B’s mistakes. What can Nurse B do about it? Not a whole hell of a lot, and nursing culture really frowns upon direct confrontation.
It’s getting better than it used to be. Unless your manager is the one doing the bullying; that’s a whole other ball of wax.
I once straight up had another nurse going into my patient rooms and double checking everything I was doing. I confronted her about it though because fuck that noise. She got all flustered and backed the hell off. Of course I got in trouble for confronting her, but, seriously fuck that shit.
2. For-profit hospitals make deals with the devil
Who likes to pretend they pay a competitive wage, forbids you from ever comparing pay, and prefers to hire new grads because they have normally have no idea what’s normal or legal? For profit hospitals!
You see, baby nurses might not know what’s considered normal in a workplace. They may not have a wise ole nurse there to guide them about things such as “Yeah, seriously, they can’t work you overtime this week and then cut your hours next week to avoid paying you overtime that’s illegal.”
For profits might also ignore the fact that their psychiatrist decided to grab a patient by the throat and push them against the wall because, you know, he’s cheap. These same companies might just ignore safe staffing guidelines because they figure if there’s no actual law saying 1 RN cannot oversee 42 acute psychiatric patients, fuck it. Saves money. With for profit hospitals, money is the bottom line. Not staff, not patient care-money. No matter how they spin it, they’re all about the money. If you happen to be paid slightly more than your peers? They’ll find a way to drive you out, and if you work for a for-profit and don’t have a Union? God help you now, my child.
3. Some patients are also servants from a fiery realm
They tell you stories, they try to prepare you, they talk about effective communication and verbal de-escalation but nothing quite prepares you for your first patient from hell. I'm not talking about someone who is justifiably upset like a guy whose blood pressure if through the roof because he’s in agonizing pain and the nurse thinks he’s just trying to get more pain pills even though his arm looks like it’s sausage in a casing. Or people who aren't handling their mother dying very well and come in drunk, screaming about how you’re all “full of Medicare bullshit” (I still can’t figure out what he meant) and need to “give her the good drugs so she dies already”. No, I’m talking about the person who isn't that sick (as compared to the lady in the next bed with an active GI bleed) but thinks they’re your only patient…even if you’re wearing the blood from the lady in the next bed.
I'm talking about the person who calls the CEO if you don’t turn their television to the channel they want when there's nothing wrong with their fingers. I'm talking about the person who screams “Nurse” when you’re talking to their room-mate. That person.
We had one woman who would ring the bell to get more blankets. Even if she had six blankets on her already. I'm not talking sheets, I'm talking thick ass comforters. If you mentioned that she already had six comforters she’d yell that she was still cold. Even though she was sweating under the covers. You could see the sweat.
And yes, I've had grown men and women who are quite capable of wiping their own asses tell me to wipe them. Because they claim, “That’s what I'm paid to do.” And remember, you’re supposed to be smiling this whole time. So when a patient decides even though they’re in the hospital for chest pain at 2 a.m. to have their significant other come in with some Hardee’s which you then have to intercept and remind them that they’re fasting for a test in the morning and that patient starts screaming (at 2 a.m.) that they’re “starving” and that this is “worse than prison” you’re supposed to stay calm and educate them on the needs of the test and the necessity for them to be fasting all while smiling and trying to ignore that you might have a more pressing issue in another room.
As you can imagine this does absolutely dick most of the time. Normally it’ll go Patient Complains to nurse->Nurse ‘educates’->Patient demands to speak to the doctor at 2 a.m.-> Nurse explains that doctors are only to be called for an actual medical emergency. ->Patient demands to speak to charge nurse or supervisor. -> Supervisor either placates patient by subtlety insulting the nurse, tries to problem solve, tries to compromise, or offers for the patient to sign themselves out if they don’t want to follow the physician’s orders.
If they do the latter, Patient will start screaming and threaten to call their insurance and tell them not to pay for this stay since “you aren't doing shit.”-> A more seasoned nurse at this time might look up the insurance company’s number for them and if they’re having an especially bad night will spell their last name out for the patient so they can spell it right on the complaint form.
There is simply no way to prepare a new nurse for this escalating hell that they will encounter at least once-especially if they’re working the night shift. Bonus if the family/patient feels that they've had to wait in the ER for an undue amount of time-even though it’s only been four hours from door to floor.
4. Some people really can’t follow directions
Let’s say you just discharged someone with pancreatitis. You review dietary restrictions and they even get a visit from the nice Registered Dietician who reviews things step by step and the patient verbalizes understanding to avoid fatty foods for the next x days. You specifically reiterate the need to avoid fatty foods. Not two hours later, you re-admit that person with an exacerbation of pancreatitis. You’re flustered. You thought they really understood things. So you ask them what happened.
“Well I ate a salad and the pain came back.”
“What type of salad?”
“The chicken crunch salad at Perkins.”
My personal favorite was the 21 year old male who came in with severe constipation after a hernia repair. What happened? It seems when they told him he could take one to two percocet every four hours, he interpreted that as he could take one every two hours. So he did. And then one every one hour, and then one every forty minutes. I know cuz his mom told me. He refused to talk to me since I made him get up and walk the halls as per the doctor’s orders. Because, by god, if you’re that full of shit you need to stimulate the bowel by any means necessary. We were already giving him enemas every few hours.
But the saddest example of this I've ever seen was when a man in his forties who had renal issues came into the hospital with chest pain. His parents were with him and did most of the talking. His mother kept going on and on about how “them doctors at Hershey didn't know what they was doing” and about how “they took him off potassium pills but I kept giving him mine because he was having leg cramps.” The man’s potassium was 6.1, which is very high.
I'm not saying that’s why he died the next day (elevated potassium can cause heart attacks) but I'm sure it didn't help.
I've learned and seen many, many things over the years but I think we've gone over enough for now. Next time we'll talk about just how much NG tubes suck (out your stomach contents).
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