Tuesday, August 10, 2021

...and that's all I have to say about that

 Some months back I posed the question: "Would I recommend nursing as a career?" 

That is a tough one.  My answer isn't an emphatic "yes".

It isn't an emphatic "no", either.   

The job I trained for, and did well, has ceased to exist.  Now that I'm retired, I don't miss the constant struggle of trying to do the job that I knew could, and should, be done.  And feeling not good about it all the time.  

Get a snack.  This is gonna be long.  

My younger self, 19 years old when I started nursing school, would not have survived it today had I not taken the path I did.  For certain I would have flunked out of my first year of training before Christmas.    

I was not an especially good student back then.  I relied heavily on clinical experiences to show me how boring textbook information could magically be transformed into easy-to-understand practical information.  The nursing part came to me much more easily because I  had a head start.  

My dad was a pharmacist who worked for many years at the smallest store of a small chain of old-timey drug stores.  It was seriously tiny.  There was candy, newspapers, and magazines for customers to pick up themselves for purchase, but most of the stuff was behind the counter and people had to ask for it.   There was a soda fountain, and a cosmetics/sundries counter,  that was it.  The pharmacist was in the back out of sight behind cloudy glass.   At 15  I worked as a soda jerk (why was it called that??)  a few hours per week... until it got ripped out and turned into the gift/tobacco counter.  If you wanted anything as scandalous as condoms, you had to ask to speak to the pharmacist, who produced it in a brown paper bag.  The customer was then doubly humiliated by paying the lady behind the counter.  When Dad became manager of a much larger store in the chain and eventually general manager of all 7, I became something of a nomad, filling staffing gaps at all the stores where I was needed: cosmetics, gifts, tobacco, pharmacy, surgical supply, and the one store that still had a soda fountain.  All for minimum wage of about $1.65 per hour. 

The summer following my high school graduation I was helping out at one of the stores with "Uncle" John,  dad's first boss, pharmacist mentor, and dear family friend.    I was chatting amiably with an older woman, passing the time while she waited for a prescription.  She asked me what my plans were for the future, as if working in a tiny chain of drug stores wasn't meant to be it.  I told her I was accepted to nursing school for the following year, and planned to try to get a job in a hospital in the fall.  Meanwhile, over her shoulder, I  noticed Uncle John frantically waving, gesturing and pointing to this nice older lady as he stood out of sight behind the prescription counter.  I had no idea what he was on about.  My future was altered thus:

"If you would like to be a nurses aide, we have a six week course starting in two weeks.  I think it is what you are looking for.  Come to my office Monday morning at 10 AM and we can discuss it".  

With that, she left the store.  I was so stunned I failed to ask for details.

Uncle John was practically dancing with glee.  "That was Miss Kennedy!  She is the director of nurses at the hospital"

After I picked my jaw up from the floor I stuttered, "She just offered me a job as a nurses aide.  I'm going in on Monday to talk to her about it".  

I was hired on the spot.  The following week I started a 6 week, 40 hour/week training course.  9 hour days filled with classroom lectures, making occupied beds, giving bed baths to Mrs. Chase, and working in the clinical areas.  Most of this would be repeated in nursing school, but more on that later. 

When I finished  nursing assistant training and was assigned to a permanent unit, the floor nurses treated me differently than the other aides.  Knowing that I had already been accepted to nursing school the following year I became somewhat of a pet project.  I was frequently pulled aside to: 

 "Come see this, come do that, do it this way, not that way".  

"Your nursing instructors next year will be crusty battle-axes bent on failing you".  

"This how you should do it.  Now, stand back while I bounce a quarter off your draw sheet".  

Aside from the usual AM care, PM care, pre-op prep, post-op care, back care, urinal and bedpan cleaning and meal delivering tasks I was sent to in-services meant for RN's, most of which were over my head.  I was taught to do EKG's and D/C IV's, do diabetic foot care and a host of other things.  I learned a lot, plus I am a good mimic, and adopted conversational patterns of those nurses I most admired when interacting with patients.  

In her later, slightly addled years, Miss Kennedy bragged about how she got me into nursing school.  

Many more years later it dawned on me that perhaps our encounter was not so serendipitous as it appeared, and suspected Uncle John had probably greased the wheels a bit.  The most important fact was that by hiring me for that job, which provided so much experience, she likely kept me from getting kicked out of school the first few weeks.   Perhaps I didn't come across as a clinical nurse-savant, but my instructors immediately guessed that I had some experience.  Knowing some clinical skills allowed me to pay more attention to extra-curricular activities study.

My diploma program provided three weekly 8 hour clinical days, which were preceded by an evening of pre-clinical preparation.   Hours and hours spent on chart review, to produce...the dreaded care plan.  How we hated those.  Assessment, Plan, Intervention, Evaluation.  I get why they were necessary, but man, were they tedious.  

Our clinical patients were assigned to us by the mid-afternoon the preceding day, because back then, the instructors knew any patients who were not discharged by noon would definitely be there the following morning.    We lowly students were allowed into the clinical area after only after 5 PM, neatly attired in dress pants or skirt (no jeans or sneakers),  a clean and pressed (emphasis on pressed) lab coat and identification tag (like nobody could tell we were students).  We would eat an early dinner in the hospital cafe, then disperse to the various floors via the medieval tunnel system attaching our  student residence to the hospital by not one, but two underground systems.  We were permitted to introduce ourselves and chat with the patient as long as we didn't get in the way of any of the nurses or house staff.   The first couple of months we had one patient, by New Years of freshman year we had two.   Having had the experience of a full patient assignment on a med-surge floor for a year, one or two patients was a luxury for me.  In those days, aides were given a full 5-6 patient assignment minus meds as opposed to the current system of the aides being everyone's bitch.  There were only a couple of clinical instructors for all of us, and as we were spread out on different floors, a lot of our supervision  was provided by the floor nurses and upper class students.  Most of them were interested in teaching us, some were not.  A few were quite mean, seeing freshman students as serial killers.  We muddled through.

As 2nd and 3rd year students we were allowed to work in the hospital as nurses aides, or overnight as patient sitters for demented, usually rich, elderly patients.  Not that we had that much extra time, and I could not manage study, clinical prep, and work more than 1-2 shifts per month, always on a weekend because it was a full 8 hour commitment.  It didn't pay much, but it was still about $.75 more than baby sitting, which I was sick of.  Anyway, we were able to earn a little cash and still get some clinical experience.   As seniors, the floor nurses were much more patient with us, and we were treated as legit extra hands instead of nuisances.  One upperclassman we revered had managed to challenge the LPN  exam before that loophole was closed forever.  She was able to work as a staff nurse on 3-11 on weekends, and for that was paid about $1.00 more an hour.  She lived on my floor in the dorm, and we assembled at 2:30 to watch with envy as, dressed in a crisp white uniform, she ceremoniously put on her winged white cap at the full length mirror by the elevator.  That cap was very different from those of our school, which were fairly petite, and could be folded so the size and shape of the wings were at our discretion.  The velvet stripes along the edge of  the cap identified us by year:  narrow gray velvet stripes for juniors, and narrow black for seniors, usually handed down from our big sisters.    Upon graduation we wore a 3/4 inch wide black band.  I bought a few yards of black velvet ribbon which I cut into lengths and shared with my friends for graduation.  

My final three months of  clinical experience was team nursing.  We functioned as charge nurses, which included assigning patients to staff, and did treatments, dressings,  and meds.  In those days report was a group activity.  All nurses and supports listened to change of shift report on all patients.  It was apparently mandatory for all staff to smoke cigarettes, and the "lounge" where report occurred was dense with smoke and littered with overflowing ashtrays.  Of course, the patients were also allowed to smoke in their beds as long as there was no oxygen, so perhaps the smoke smell wasn't as obvious.  

As advanced students we could hang IV bottles (yes, bottles) and monitor flow rate, (no pumps in those days) but no IV meds were given on the floor except antibiotics.  An IV team did all the starts, transfusions, and trouble shooting.  They were kind of fanatical about it as I recall, but I learned a lot from watching them.  We were never allowed to learn IV starts in school.  "When you graduate, they will either teach you or have an IV team".   As it happens, I taught myself working nights on a surgical floor, but that is a story for another day.   We gave hundreds of IM injections as medication for pain and nausea were all IM.  I don't recall that too many people were willing to have a shot in the butt every 4 hours for a prolonged period of time, and patients seemed to quickly progress to PO meds.  On the ortho-urology floor we had total hips, a couple of Stryker frames for spinal patients, and lots of 3 way bladder irrigations.  Plus various traction apparatus to play with.   I did this for 3 months.  Because there was an odd number of students in my clinical group, everyone else had to share and got only a few weeks as team leader.  This clinical experience prepared me for my first job out of nursing school as a 3-11 charge nurse on a level 4 rehab floor.  My staff consisted of an LPN, 3 aides and an orderly, all under the age of 29.  I was only 22, one of my aides was 18.  The kids were surely home alone. We were all stupid, but hardly anyone died.   I will leave the story of my first unexpected death for another time, along with details on doing post-mortem care carried out by reading the instructions provided on the pack.  Hilarity ensued.  The 18 year old aide, my roommate at the time, was scared shitless of dead people.  

So, that is kind of a long way around saying that had I not had the clinical experiences I had, I would certainly not have been successful.   It was a good fit for me, I felt like I learned the right way with the right teachers, and was given real-world experience before I graduated.  Mostly med-surg experience year one (lots of chronics), junior year we had pedi, acute med-surg (which included the OR), and OB.  As seniors we had psych, ICU (which included the ER), and Team, although it was actually called Leadership.  Three months in each rotation, two days of lectures, three 7-8 hour clinical days.  

It was a long time ago.  And a far cry from not only the preparation, but the way nurses are allowed to practice nursing.  Learning how to be a nurse wasn't rushed, information wasn't crammed in, and most importantly patients weren't treated like they needed to be shoved out the door.     

Today there is little time to spend with patients who need a bit more encouragement, better teaching, some hand holding.  There just isn't.  What has been systematically robbed from the joy of the job is the human aspect, making someone feel better not just by the things we do for them, but for the things we say, the time we spend, the connection we make.  I saw this first-hand with my husband's heart surgery last year.  Once out of the ICU, it was the aides who did all the care.  He saw the RN twice per shift, and for meds, unless he had a question the aide couldn't answer.  I don't think nurses sign up for this kind of digital, tech heavy, documentation-centered, task-oriented patient care, paying more attention to the computers they must lug behind them.  I know I didn't.  But that is the real world of nursing in the corporate environment.  You can't give the BEST POSSIBLE care to everyone.  If you think that, you are delusional. At the heart of it, there is no monetary value in the very thing that draws people to nursing in the first place. 

Is there any career  that is as idealized as nursing?  Yet, the reality is so far from from the expectation.    I loved being an ER nurse, but bedside nursing has become increasingly unpalatable to new nurses.  Who could blame them?   I got to dislike being abused and treated like an idiot by bullying clipboard commandos and entitled consumers.  Physical violence, verbal abuse on a daily basis.   Never has nursing been less respected; what a sad state of affairs, especially after the last year when nurses were hailed as heroes.  In my opinion, referring to nursing as "a calling" is bullshit, universally utilized by management to undercut nursing, and by nurses to rationalize it.   People need to be right for the job, same as any other career.  For the people in the back, SAME AS ANY OTHER CAREER.  

Alas, as I have said for years, there are no utopias in nursing.  

 Would I have chosen another career?  Maybe.  There are so many more options now, so many more opportunities for learning and individual growth.  It's no wonder that caring, dedicated, educated and experienced nurses are leaving the bedside in droves for better pay, better hours, and better treatment. Or leaving nursing altogether.   Who can blame them?  They SHOULD have little tolerance for the way administrative and clipboard shenanigans interfere with the ability to give excellent patient care.

I think anyone who wants this had better go into it with eyes wide open.  It can be rewarding, and devastating, satisfying and heartwarming.  It can be punishing.   I speak from my 40 plus years as an ER nurse, from my heart which is broken from what nursing has become.  As patients get older, sicker and more complicated, the burden on nurses will continue to increase.  I hope that the next generation of nurses will take a stand, be the agents of change, and demand better.  Someday, and who knows it may be sooner than I like,  I would want such a nurse to take care of me.