a little of this, a little of that

Where to start? Why haven't I posted in awhile? Well, because there's too much to say, and not enough all at the same time. Maybe we'll just start with some simple updates. There has been some exciting news lately!

First, just before Christmas, I was in a patient's room when another nurse came to the door and said, "There's someone here to see you."

"Who is it?" I said, but she had already walked away. As I finished up and washed my hands, I figured it was probably one of the therapy dogs, since they know to look for me and beg for me to get out my secret stash of Milk Bones.

But walking to the charge desk, instead I found Gina. Gina! You remember Gina, who teetered on the edge while waiting for new lungs and finally received them. There she was breathing nothing but good old room air, walking unassisted with her family. She looked so different! No longer the cachectic woman I once knew, this Gina was round and puffy, the poster face for steroids.

"I'm doing really well," she said. "I came to thank you all. We're moving out of our apartment here in town and heading home for good next week."

She and her husband were all smiles. We were too.

Then, just the other day I ran into the medical student who I had worked with when I cared for Rosa, the woman from Mexico. The student had continued to follow Rosa after she was transferred out of ICU. Turns out, Rosa became just one of those people who squeaks through without dying or becoming disabled and slides quietly out the hospital door into a nation full of opportunity. She was healthy enough to leave the hospital independently, so this attentive student found her some clothes and shoes. Rosa's husband hired someone to safely transport her deep into middle America. The student helped her get outside to the right place at the right time, and off she went.

Now, on to the reason I'm not writing too much these days. I'm not exactly sure what it is, but I think it has to do with the fact that these stories, these dramas, are so infinitely complex, so thick with loss, joy, and unknowns, that they are hard to package up neatly. Even when I give myself permission not to do the whole thing justice, it is still really hard. So sometimes I just go about my work, processing things internally but not forcing that next layer of sorting out that might be required to write coherently.

Sometimes, when you are tired through and through, there is honestly nothing left for such luxuries. When you work in a profession where hard, good work is rewarded with more responsibility but often no more money or power, that can feel very defeating. This is coming from someone who now has the joy of being charge nurse.

Now, don't get me wrong. Sometimes being charge is really cool. If it's a really weird day and we're actually adequately staffed, the charge nurse stays out of ratio (i.e. does not take a patient assignment). Instead, he or she is the helper bee, scurrying around looking for fires to put out, people to help. You're the go-to guru for any problems, whether they be clinical issues, interpersonal issues, material/supply issues, safety issues, etc. It's all fair game. So, when the unit is humming along, nice and busy but staffed adequately with enthusiastic, energetic, smart nurses (like so many of my colleagues are), that job is really fun! I get to run around and do whatever is needed, problem solve all kinds of wacky stuff and learn a lot in the process. I get to make sure everyone gets to eat lunch, which I think is hugely important! Having people who get to take a thirty minute lunch break during an intense twelve hour shift of monitoring and responding to the needs of unstable patients is an obvious plus for safety, right?!?

But what about those days when things aren't so cute? We're short a nurse (or two, or three) so I've got an assignment that I can just barely manage. I can see my colleagues struggling too, and there's not too much I can really do for them or our patients, besides run faster and faster. We have to do the best we can. What's really frustrating about these scenarios is that we have basically zero control of what is happening. We can say to the nurse house supervisor, "This is not safe. This is scary. We are uncomfortable with this." Or, "We're stretched to the limit right now. We're okay, but we cannot safely take another admission into the unit with our current staffing." But, all we can do is say it. We have no actual power in these negotiations. And anyway, we're so busy, we hardly have time to pull our heads up above water and look at the total picture of our surroundings.

It's kind of frustrating when you realize that you get stuck in this bad position precisely because you do good work. Serving as a decision maker and resource for the unit is great. But being forced to put aside your good judgment (perhaps the very thing that earned you this post), battle hard and often unsuccessfully for your staff and your patients, and make no additional money is pretty crappy, don't ya think? No wonder so many intelligent, motivated nurses choose to pursue advanced practice. It's not necessarily because bedside professional nursing does not satisfy their need for challenge, investigation, and reward. Rather, perhaps it's because they are uncomfortable taking on increasing responsibility along with minimal control over things in which they are quite expert, minimal recognition of their contributions by other disciplines, and stagnant financial compensation. There will be no easy fix for this nursing shortage.

By the way, you might be interested to know that the National Labor Relations Board recently ruled in it's "Kentucky River" decision that permanent charge nurses in a Michigan hospital are considered "supervisors" and are thus ineligible for union protections. This potentially leaves these nurses in a very bad spot. You can learn more about this in the January issue of American Nurse Today, the journal of the American Nurses Association.