nightmoves

Please don't make a value judgment until you have walked a mile in my moccasins. I have been a nurse manager for the past eleven years, prior to that I had been pushed towards assuming a leadership role for five years, so I decided that perhaps somebody or something was trying to tell me something and perhaps I had better listen. It is frustrating to have to balance needs of different groups, juggle budgets, listen to people who do not want to see you until they have a problem and then expect you to fix it, preferably five minutes ago. I have been in the position of working for some really bad nurse executives who are so busy sucking up to hospital administration, wealthy contributors, and the medical staff that I doubt they can even find the floor. I am not salaried (I am overtime eligible, but administration has a way of making your life miserable if you try to claim overtime,) and routinely put in forty-eight hour workweeks. The only reason I stick with this job? I get to be a role model. I'm not above picking up a bedpan, starting an IV, or covering for breaks and holidays. I would miss patient contact if I didn't, and it provides me a chance to maintain my skills, assess patients, and assess nurses' performance. Once in a while I get a chance to impact the system by working with it and improving things in some small way for the nursing staff I am privileged to work with. I despise it when I hear nurse managers refer to "their nurses" (after all, they outlawed owning people in this country in 1864) and I do not ask staff to do anything I would not do myself. I have informed upstart physicians that I was doing surgery when they were fingerpainting, have formed some collegial relationships with other departments, and yes, I have some enemies. I almost enjoy the young nurses who present themselves stridently as "advocating for patient care" and sometimes make my life a little more difficult, they remind me of myself so many years ago when I thought the mean old supervisor never worked at the bedside herself and was clueless as to what it took to do so. As a child of the 1960's I learned that the best way to change the system is to work within it. That is why I took this job. Sometimes I get real lucky and can do something really positive. The high I get from that carries me for a good six months, through the times when the overtime budget is off the chart, there are eight people out on sick leave, and a struggling orientee who doesn't seem to "get it" and leaves me no alternative but termination. I decided a long time ago that I am the one who has to look at myself in the mirror, and that as long as the Creator and I approved of my actions, it didn't really matter who else did or didn't. I go to work and do my job, which sometimes means confronting a nurse who should not be supported. I don't like this but don't shirk from it. I guess I have set limits enough that the physicians we encounter do not throw temper tantrums, and I recall pushing one sexually preoccupied attending into the treatment room after he pawed me, getting into his face and telling him that if I ever caught him doing that to any nurse under my supervision never mind the human rights committee, I would get on the phone promptly and call his wife. (The look of terror on his face was priceless.) I do not play games like screaming on the phone to other people in front of the staff so that staff will think I am supporting them, but I try to resolve issues one on one with other managers and departments. I'm no saint. Sometimes I hate my job and want to just hop a jet to some tropical country and sip a Mai-Tai. Sometimes I get good ideas and can implement them. Sometimes I'm successful. Sometimes I'm not. Sometimes I make mistakes. I admit them, learn from them, and move on. So I don't know where I'm going with all this, and I volunteered for this, so I don't pity myself. I just ask that those of you who do have aspirations toward nursing leadership to remember that the manager peering over his or her reading glasses at your documentation, your schedule, or your sick leave usage is a human being and an RN.

God bless all of our brothers and sisters over there, and may the Creator keep their bodies, souls and spirits in His loving care. --from an old Army nurse who still remembers and grieves.

When I was in the service during Vietnam and fresh out of training we had wounded brought in from an aid station via dustoff (helicopter evacuation.) The medic had done a pretty nice job of packaging the wounded GIs and I was being oriented to triage. I stepped in a blood clot and ended up flat on my derriere between two litters, so I decided to start my triage right there. Getting up into a squatting position, I turned to the patient on my right and started my brief head to toe assessment. Pupils dilated, sluggish, reactive, equal. Carotid pulse 110's. Respirations 30 and shallow. No neck or thoracic wounds. Large Elastoplast dressing covering the abdomen. I noticed pooling around the injured man's flank, and tentatively touched the edge of the dressing while calling for one of the surgeons. The Elastoplast must have been ready to let go, because that is exactly what it did. As it rapidly retracted, the injured man immediately eviscerated. I was absolutely horrified, and assisted the surgeon in wetpacking the exposed organs. He was immediately transferred to the OR and successfully debrided, but succumbed to sepsis and pulmonary edema a week later. I have never forgot this incident, and still occasionally have nightmares about it, although I was assured again and again by the surgeon, my chief nurse, and the hospital commanding officer that I did not kill the patient. (It was a miracle that he had survived the initial blast, the helicopter trip, and the surgery.) Despite years of participation in veterans' groups, I will never forget that young man. When I talk to young colleagues who signed up for the reserves when we were at peace because it seemed like a good way to earn a car payment, I wonder how they would react emotionally to such an incident. Fast forward twenty-five years to an oncology unit, where I was in the role of a nurse leader. We had admitted a breast cancer patient who had a late diagnosis and an extremely necrotic breast with an odor that I have not smelled since South Vietnam. She had obviously metastasized, a CT scan earlier that day had showed pulmonary and bony involvement. She was febrile and her blood pressure was dropping despite antibiotics and volume expanders. Unfortunately, the attending had not broached the subject of her prognosis with her that day, and she was a "full code." And naturally, that is exactly what happened that night at about 2:30 AM. Since the unit staff had not gotten a backboard under her prior to initiating CPR, I grabbed the headboard off, moved to the side opposite her necrotic breast and started to roll her over to place the backboard. I suddenly felt something heavy, warm, and wet on my foot--it had sloughed and fallen off right onto the new shoes I had just bought that day. Sorry these incidents aren't funny, but you asked disgusting, and these take the cake.

When I was rotated back Stateside to the OR of a military hospital which shall remain nameless I was assigned to the GYN room for a little while. Having worked primarily trauma while in country (not much GYN on a battlefield in those days) I was not totally familiar with a total abdominal hysterectomy. Samples are identified verbally as they are handed off to the circulator, who labels them and packages them for pathology, bacteriology, or wherever. As anyone who has ever been in an OR knows, masks muffle conversation. The scrub nurse handed me some tissue in an emesis basin and said what sounded like "left over." And I said, "Well, put it back!" And the operating team roared with laughter--they had just excised a left ovary!

I was on active duty in 1973 and 1974, and have always loved MASH. China Beach, however, reduces me to tears for the most part. Of course, I remember Ben Casey from when I was a little kid. Can't stand anything post-China Beach.

Interesting discussion. Several years ago I worked for the NYS Department of Corrections, just at the time that a new governor was elected, primarily due to his pro-death penalty position (Please note: New York has not executed anyone since the death penalty was put back on the books, and in this state only 1) felony murder or 2) murder of a police or other law enforcement official are capital offenses.) At that time I recall a staff meeting with our nurse administrator who said that no role had been identified for a nurse in the execution process (even though our facility was not the designated "condemned" facility I find it interesting that he would stress this point.) The ANA Position Paper was cited during the course of this staff meeting. Several of us had the reaction of "Yeah, but I'll push the Norcuron first!" where the rest of us wanted no involvement in the entire mess. My personal take on this is that our legal system, while probably the best in the world in ensuring the criminal's rights, is, after all, flawed because all human activity is flawed. Nor have I ever considered the death penalty as the ultimate punishment. If you have ever smelled the stench of a Special Housing Unit (disciplinary unit) on an 85 degree day with an equal relative humidity, you would know what living hell is. Without entering into the presumed guilt or innocence of any particular condemned inmate, I would like to point out that the average cost to the taxpayer to execute an inmate, by the time legal appeals are exhausted, is in the average of $5 million dollars. This, of course, includes the cost of housing that inmate until execution, so it does not just reflect legal costs. I feel that a far better penalty is to lock them up and let them rot.

Please reread Lillian's advice. To which I would add: Additionally, if acuity has suddenly increased (i.e., if the night is really going to hell) contact the nursing supervisor on duty and ask for help. The sup is in the position to redeploy staff from less acute sites, and many sups will come down themselves to help out if they can. At the very least, contacting the sup validates the fact to your head nurse that things really did go to hell quickly.