Let me introduce myself. I'm the nurse, the one at the bedside. It's a place I've occupied for twenty-four years. There are millions like me. You might see me as an underachiever, someone who didn't have what it takes to get into med school to become a doctor. Or you may think I'm stuck here because I'm not motivated enough to become a charge nurse, a department manager, or a director of nursing.
It's true that quite a few RNs who used to work here beside me have moved on to management positions or other areas of advanced practice, becoming nurse practitioners or nurse anesthetists. Some got masters or doctorate degrees and went into teaching or research. Their successes in their chosen areas are admirable. We need good people in specialties, management, and education.
It's also true that some friends and former coworkers left nursing altogether, choosing paths that placed them in areas commonly believed to be superior to what I do. One friend started a medical equipment company that eventually went public, making him a multi-millionaire in a matter of hours when the stock tripled during the IPO. One left nursing to become a lawyer, successful enough to run public adds promising big winnings for car crash injuries or slip and falls. One went to work as a financial consultant for a major Wall Street firm which manages 401Ks for hospitals. He laughs when he says, "Hey, we're paid to have an opinion. We're not paid to be right." He makes eight times as much as I do. Some left to be representatives for pharmaceutical companies or equipment suppliers. One RN cut back her hours to moonlight as an expert witness. She gets paid well to pick apart the scant written record which barely hits the essential highlights of everything the nurse at the bedside does to care for the patient. She says, "I sometimes feel a little guilty testifying against nurses because I know how hard it is just to keep my head above water on busy days. There's no way we can chart everything we do. But this is how the game is played; I didn't make the rules." For those who chose to advance your careers by leaving the bedside for whatever reason, I can understand and appreciate your choice.
But for those who assume I stopped and stagnated here, settling for "something less," because I wasn't capable or motivated to advance my career away from the bedside, please, let me tell you how I got here and why I stay.
I had a four-year bachelor's degree. I sat on boards of directors responsible for multi-million dollar budgets before going back for my 5th and 6th years of college education to become a nurse. I maintain certifications in BLS, ACLS, PALS, and the NIH Stroke Scale which are mandatory to be a staff RN in the ER. Trauma Nurse Core Course is optional, but I took it anyway. Certified Emergency Nurse is also optional. After testing for the first two certification cycles, I've chosen the continuing education renewal option, completing 100 hours of classes in my clinical area to qualify for each of the next four certifications. My hospital has forty-six annual mandatory online training modules covering everything from fire safety to services animals. There are ongoing in-services and annual skills fairs covering the safe operation of the wide range of sophisticated equipment in our department. Not a day goes by that I don't pick up some new tip on technique from a coworker or piece of information in some obscure area that sharpens my skill and knowledge base. My intuitive ability to discover the real story behind the illness gets sharper every year.
Could I leave the bedside for any of the options noted above? Sure. Absolutely. But I choose to be here because this is where most of the actual patient care happens. Twenty years ago, I was accepted into a NP program with financial backing form my employer, but I choose to pass on the opportunity. When I listed the advantages and disadvantages on paper, for me, in my situation, the only real advantage I could see was higher pay. I prefer more direct interaction and hands-on delivery, even if it means getting paid less. In the ER, I watch the doctors and PAs do their two-minute assessment then disappear while I take care of the patient for the next two hours. When everyone else does whatever it is that they do--administrate, manage, write polices, debate ethics, study productivity charts, evaluate patients and write orders--at the end of the day, the lives of the patients and the care that they receive are placed into the hands of the nurse, the one at the bedside. Can you top that level of responsibility and reward? Do you really want to label me a stagnant underachiever?
There is a bit of poetic irony here. If you see the bedside as a lesser place in the grand universe of healthcare, remember that the odds are heavily stacked that someday you will be here. Everyone who's never been here before will end up here. Everyone who's left the bedside will be here again. Someday, either as the patient or the distraught family member looking over my shoulder, you'll be back. You'll feel helpless and vulnerable then, and rightfully so, because your accomplishments, your power, your expertise and your money won't matter. When that day comes, I'm all you've got. Even if your skill is still intact, you won't be on the clock. You will look on, hoping and praying that I get the IV started on your dehydrated four-month-old who's becoming lethargic or your eighteen-month-old who's actively seizing on arrival in the ER. You'll watch anxiously as I attempt to get a catheter past your husband's swollen prostate to relieve his painful urinary retention when two other staff members have tried and failed. You will quietly wring your hands, praying that I correctly manage multiple infusions to pull your mother back from septic shock. You'll watch helplessly as I insert a bite block, an Ewald tube, and perform a gastric lavage on your brother who overdosed. When that day comes, any hints of disdain or condescension will go out the window, when your life or life of someone you love is in my hands, the nurse at the bedside.
The good news is that I will be here for you. The years of dedication, learning, honing my clinical skill, and "advancing my career" in the same place I've occupied for twenty-four years, will all be to your benefit. I will confidently take your life, the life of your infant, your child, your spouse, your uncle or your grandmother into my hands. And I won't let you down. It's what I signed up for; it's where I choose to be. It's who I am. The nurse at the bedside.
