The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital (25 page)

Nothing had come of Fatima’s meeting, as far as Lara knew. Administrators couldn’t fire a nurse without a concrete case. Lara had noticed that Fatima was arriving early and staying late, another tactic Lara had used. She often entered other nurses’ patient rooms, clearly, Lara thought, looking to score leftover vials.

Working extra hours wasn’t necessarily a red flag to someone who hadn’t been in Lara’s shoes. Some nurses worked 3:00 p.m. to 7:00 a.m., a full sixteen hours. Recently, Lara had spoken with a nurse who had worked twenty consecutive hours. “You can work twenty hours? That’s safe? How is that even legal?” Lara had asked him.

“I don’t know, but here I am. It happens all the time,” he replied.

Lara continued to devote herself to her Relationship-Based Care committee work. December could be an especially tough month for nurses because they had to deal with their patients’ anxiety on top of their own holiday stress. The committee was encouraging people to make a conscious effort to be nicer to each other, with posters in the staff bathroom and reminders during meetings. They turned “RBC” into a mild reminder for coworkers to calm down. Rather than telling a nurse she was acting like a jerk, staffers would joke, “Hey, check yourself, that’s not very RBC of you.” Since the formation of the committee, there had been no fights on Lara’s shifts. The committee hoped the more empathetic atmosphere would improve employee relationships and the ambience for patients. As Lara said, “What if you brought your kid into the hospital and you saw nurses calling each other skanks?”

Lara also suggested that the department have huddles at every change of shift, so the day’s entire team could touch base about who would be working where and whether they needed more assistance. Lara explained, “The huddle is about how we can work well as a team. If you’re in triage and you do blood work for the nurse in the back, that’s going to take a load off her. A lot of people weren’t happy because some trauma nurses sit and do nothing when there aren’t any traumas. That’s one of the main things: If your area isn’t very busy and you have the time, there’s most likely someone who needs help, so what can you do to help them?”

Lara led the ER’s first huddle. “Okay, team, today’s going to be a good day,” she said. “We have ten nurses working today. Rose is charge. Rachel’s doing trauma. Peter is in triage . . .” She listed each staffer’s assignments, including the cleaning crew she had invited to the huddle because they were part of the team, too. This way, everyone knew they were accountable for their area, and also the entire group knew where the weaker or new nurses were, and could help them accordingly.

“Anyone got anything going on today? Willa, how are your knees?” Lara asked a nurse in her sixties.

“They feel rough today, baby,” Willa said.

“Okay, everyone, we gotta look out for Willa. If you see her pushing a stretcher, go help her. She should not be pushing a stretcher today,” Lara said. “Guys, remember there’s no ‘I’ in team. We’re all in this together!” She punched a fist in the air, intentionally cheesy. The group laughed and scattered to their zones.

The nurse manager told Lara that the huddles were the most helpful and positive meetings the department had ever had. Hopefully, once the huddles became routine, administrators would join them.

Lara’s next idea was to set up a specific room for post-trauma crisis intervention. The committee was still working on developing ways to help the staffers after something devastating happened, as with a recent case in which a 12-year-old died from a bullet wound. “People die on our shift, sometimes several people in one day, and then we just go back to work. Imagine if you just did CPR on a kid and it didn’t work. Then you deal with coworkers who are being rough on each other, and patients are angry because they’re waiting. And there’s no downtime,” Lara explained. “You can only hear a mother scream after coming to see her dead child once and you will be affected by it. That scream, I can’t even begin to describe it. The secretary answering the phone, security, janitors, everyone—they’re hearing this incredible anguish and are expected to be unaffected by it.”

At the start of a committee meeting, Lara presented her idea. “I was thinking we should have a debriefing room, a place where we can gather our thoughts after something awful happens. Everyone from the nurses who worked on the patient to the janitor who mopped the blood off the floor could take five minutes to think, talk, or pray.” Lara thought this strategy could ease the tensions that were typically high for hours after a tragedy.

“That’s a great idea,” said a tech. “We need a place to go and sit for a minute.”

“Which room should we use?” Lara asked.

“We could use part of the lunchroom,” said a unit secretary.

“Then we’d be focusing on eating instead of catching our breath,” a floor nurse said.

“Why don’t we use this room right here?” asked another nurse. “It’s only used for meetings sometimes anyway.”

The group became animated as they came up with low-cost ways to make the room more serene. “We could put in one of those little waterfall-on-the-rocks things!”

“And a white noise machine with peaceful sounds.”

“I have the perfect picture I can bring in to put on the wall.”

“I could bring in some lavender, that’s a therapeutic smell.”

“Ooh, I have a cool plant I can donate.”

Lara was so excited that once the committee settled on colors for the room, she volunteered to purchase the paint out of her own pocket.

•   •   •

Two weeks before Christmas, Lara went to her mother’s house one last time to finish clearing it out before it went on the market. She posted on Twitter that she was having a sad day. In the middle of the night, Lara opened her laptop and scrolled through dozens of replies about her mother and the house, which had been the neighborhood hangout. The uplifting messages made her smile.

Then she read the next post on her Twitter feed: John had tweeted to a woman with a half-naked photo, one of those porn star models that hundreds of men posted to daily, “Alabama, you’re so hot. I want to put this picture on my truck.”

Lara knew that John had cheated on her in the past, she knew about his gambling addiction, she knew about his sex addiction. But to post something like this where all of their friends and family members could see it, right after Lara’s tweet about mourning her last day at her childhood home? No. Lara was done. People had told her that the last straw before a divorce often was relatively insignificant compared to past transgressions. She understood that now.

Lara turned on the light in the bedroom. “Hey, John, when you tweet to another female, like your friend Alabama, everybody sees it,” she said. “So now everyone we know is looking at your conversation with the porn star.”

John jumped out of bed, looking panicked. He ran to his computer and started deleting tweets. Lara took a deep breath and whispered a quick, quiet prayer: “Please give me the strength to do this.”

“John, I cannot do this anymore,” she said, her voice steady. “I’m going to move out. You have health insurance. Get help for this sexual addiction. You need to make an appointment.”

“Stop playing this bullshit game,” he said.

Lara had thought for sure that he would beg her to stay, but he didn’t. “I’m not going to your family’s holiday party tomorrow,” she said.

He didn’t believe her. The next morning, he loaded the car while Lara finished feeding the kids breakfast. “Just get your suitcase and come on,” he said.

“I’m not going,” she said.

“Get your goddamn suitcase. You know you’re going to go.”

“No, I’m not,” she said.

He looked momentarily surprised, then began to usher the kids out the door. Lara kissed her children good-bye and told them that she had to go to work. As soon as the door shut behind them, Lara burst into tears. She was proud of herself for finally standing up to him, but wondered, still, whether she was giving up too soon.

After twenty years of working as a cardiac nurse in Washington State, Elena Uhls became so stressed that she sank into a major depression. The combination of the unit director increasing her patient load to twelve at a time, the nurse manager asking her to perform tech duties on top of her own, and patients and techs treating her disrespectfully had broken her spirit to the point where she grew suicidal. “I was crisp,” she said, using nurse slang for “burnt out.” “I felt worthless. I made errors, forgot things.” She considered switching careers, but she couldn’t imagine herself in any other job. “I was so paralyzed. I knew it was possible that I’d accidentally kill somebody if I didn’t take time off. Every day as I drove home, I slowly plotted my death. Depression is painful; suicide felt like the only way out.”

Once she found a helpful doctor and took antidepressants, Uhls recovered her basic mental health, but she isn’t the same nurse she used to be. A traveler, she floats among hospitals, avoiding the workplace where “every day was a nightmare.” She said, “I know in my heart I’m not that loving nurse I once was. If I can make a difference, I try, but what can I do in a few hours? I [used to] try to be their coach, their cheerleader, their educator, whatever it took, but not now. I still care, but not with the same light heart. It’s more businesslike. Maybe it’s better that way.”

We rely on nurses to be our healers, our heroes, to comfort us, to soothe our hurts and salve our psyches. But how often do we pause to wonder who takes care of the nurses?

Nationwide, nurses’ top health and safety concern is the effects of stress and overwork, according to the ANA Nursing World Health and Safety Survey. More nurses are worried about this issue now than in 2001, when the average shift length was shorter and patient loads were lighter. Their second biggest concern is that they will suffer a disabling musculoskeletal injury because of their constant heavy lifting; throughout an eight-hour shift, a nurse lifts an average of approximately 1.8 tons.

Injuries are a major stressor for nurses, who must lift and move patients in addition to working on their feet most of the day. The number of nurses reporting work injuries has increased in the last decade. The ANA found that “Nearly all nurses still indicate that they have worked despite experiencing musculoskeletal pain, including eight in ten who say it is a frequent occurrence.” Other common nurse injuries include needle sticks, strains, sprains, bruises, cuts, head injuries, broken bones, or dislocated joints. A Virginia women’s health nurse added, “Many nurses have bladder issues by age fifty. ‘We don’t pee so you
can
!’ How’s that for a women’s health nurse motto?”

A number of nurses interviewed for this book reported feeling overworked, overwhelmed, and underappreciated for several reasons. For twelve to fourteen hours at a time, they must demonstrate physical and emotional stamina, alert intelligence, and mental composure, even if they are berated by patients or bullied by doctors and other coworkers. Many healthcare employers don’t engage nurses in decision making, although nurses are at the forefront of patient care. Nurses are under pressure to work quickly and correctly, taking sometimes contradictory orders from professionals who will blame them if something goes wrong. They are stressed because, an Oregon nurse manager said, they are responsible “not only for the patient but also the family, the team of support specialists, hospitalists, physical therapy, occupational therapy, social work, hospice if needed, meals, medications, teaching, spiritual support, keeping the patient clean and comfortable and documenting, documenting, documenting.”

Nurses must constantly face traumas, tragedies, and patients who will die on their watch, no matter what they do. A New York City pediatric ICU nurse recalled, “The other day, one of my coworkers said, ‘I’m taking care of a brain-dead baby today and I just can’t take it.’ When there’s no hope left, that’s when it gets really sad.” Nurses are expected to care for the dying, to save the degenerating, and to minister to all manner of injury. And they are expected to do it without breaking their composure. “Some nurses are exposed to repeated horror on a regular basis, things that a regular Joe couldn’t handle,” said a Virginia NICU nurse. “The worst thing you could ever imagine seeing, we see at work. My hospital doesn’t have anything in place to help. If you can’t deal with it, you leave.”

While doctors and other hospital personnel are also exposed to death and suffering, nurses may be more susceptible to the lasting emotional impact. Nurses spend the most time with patients individually and have a hand in every level of their care. “Nurses are not only ‘first responders,’ but are also ‘sustained responders,’ ” author and clinical nurse specialist Deborah Boyle has observed. “Nurses become part of a mosaic of caring within a family framework that may be fraught with anticipatory loss, tension, disbelief, and physical disfigurement. In the acute care setting they are responsible 24/7 for the patient’s care and the family’s response to the illness trajectory. Often, they cannot leave the situation after bad news is shared or a death has occurred. It is this extended time and the placement of the nurse at the center of the interchange that makes nursing’s role unique.”