Life at the Bedside: Reflections on Nurses' Week

Well, another Nurses' Week has come and gone, and here I am, thinking about what being a nurse means to me. After a whirlwind 3 years of going from healthcare heroes to conspiracy deniers/theorists to vaccine pushers to overpaid, greedy money-grubbing travel nurses...to say I'm spent would be an understatement. This isn't the light-hearted, butt-baring prose that frequents my blog, but it's real, it's raw, and it's important. So bear with me, and know that I don't spend all of my time in this headspace, but I'm here right now, so here we go. 

I was taking care of several elderly patients recently, and I was busy...there were multiple things happening all at once: call lights were dinging, bed alarms were going off, IV pumps were beeping, blood sugars were low, blood pressures were high, pain was present in broken hips and pleuritic chests, bladders were full and bellies were hungry. I was frustrated, trying to best manage my time, and of course, there just wasn't enough help. There never is. I found myself getting impatient with one of my elderly ladies as I helped her to the bathroom (because I was thinking of all the other things I had to do), and I just stopped and said to myself, "Stef, this woman is someone's grandma; you need to take the best care of her that you can because this little lady is very important to someone." I will get to why having to check myself like this at an hour into my shift is destroying my profession one self-talk at a time. My grandma was inarguably the most important person in my life. I miss her so, so much, and even though she's been gone for almost 13 years, I still mourn her like I lost her yesterday. It is devastating to me that I will never see her again while I walk this earth. I like the idea of seeing her again someday, maybe across the Rainbow Bridge, with my pugs Brie ("she has a V on her head!") and Cooper on her lap, Ladybird by her feet, all of them waiting for me to join them in whatever comes next. What a great thought. Side note: I don't really believe in heaven, but if there is one, I'm pretty sure the best people go wherever the dogs go. So as I was helping my little lady, I thought about all the nurses that had taken care of my grandma in the hospital in the later years of her life. I thought about how they treated her, if they were patient with her, if they thought of her as someone's grandma. I also wondered if she got the nurses who saw her as the time-consuming deaf little old lady in room 5 with stress incontinence who required 2 people to get her out of bed because she had compression fractures in her spine and it was painful for her to move, and wondered how they were going to get everything done with their other patients if they were having to help her to the toilet every hour. Did they ever think of their grandmas while they were taking care of mine? Were they patient and compassionate? Or were they short and frustrated? I'm sure she got both kinds of nurses, but I hope she got more of the former and less of the latter.

A funny hospital story about my grandma: she was hospitalized for a urinary tract infection, and Simon and I went to the hospital to visit her while she was there. Knowing that the staff was busy, I decided to help my grandma with some personal care. Grandma was so excited to see us that she continuously chatted away. She didn't even stop talking while she was brushing her teeth...there was toothpaste literally everywhere. I couldn't stop laughing. She was such a funny little old lady, and that teeth-brushing moment is one that I keep near and dear to me, always.  

When it comes to patient care, I wish I didn't have so much of my time tied up with bureaucratic nonsense. And by bureaucratic nonsense, of course I'm talking about charting. It's funny, I remember thinking that moving from paper charting to computer charting was going to streamline everything and I'd have so much more time to take care of my patients. Ha! If I could have only foreseen...not that it would have changed anything, it was just the way the healthcare world was going. Computer charting has become an epic time-suck. There are unlimited opportunities to add this metric and that metric to our required documentation. I was on a computer charting committee back in the day, back when I still felt like my opinion and input was valid, and I distinctly remember the day that we spent an inordinate amount of time with administrators and the IT guys debating over what word should be on the button indicating medication administration..."Given" or "Administered." I remember making eye contact with an ICU nurse who had been lured into the same committee, and we were both like, "What the f*ck are we even doing here?" Computer charting companies and the hospital admins can add row after row of things to document on...not because they're necessarily needed, but simply because they can. This is an oversimplification, of course, because hospital reimbursement drives a lot of the things we are required to document, but that's a tale for another time. In short, the more we chart, the more it looks like we're properly doing our jobs. We are required to chart on certain things hourly, and we're not allowed to copy/paste, even if nothing has changed. Funny enough, doctors are allowed to copy and paste their hospital notes, which leads to so much inaccurate information, but again, a story for another time. The impression seems to be that if we're manually charting everything, every single hour, then we're also doing everything that we're charting (manually charting even a few things on 5-6 patients every hour over the course of a shift doesn't leave a whole lot of time for patient care, by the way). Add to that the reality of different flowsheets not communicating with each other, and suddenly I'm double and triple charting the same thing in multiple places. Anyone can chart anything they want, let's be clear about that. Just because it was documented, doesn't mean it was done...it just means it was documented. Checking boxes and crossing T's and dotting I's, all so the upper admin can get page after page after page of whatever metrics they find most important at the time. The funny thing is, I'm not entirely sure how much they actually care about whether or not the work is being done, they just want it documented so it looks like it's being done. Whenever I've been pulled aside to discuss a discrepancy in my charting, it's never, "Did you do this thing?" It's, "Can you go back in and chart this thing [so it looks like you did it]?" They don't want to know if I did it or not, in fact, I think they'd rather not know, because if I didn't do it, then they have to do something about it; it's better for everyone if I just document that I did it, then no excuses or time consuming supplemental re-education are necessary. 

This is one of the reasons that nurses like me are leaving healthcare...because we just feel so awful about diverting time from actual hands-on care to sitting at a computer checking one more useless box. Does the patient sitting in diarrhea care that I documented that they were sitting in diarrhea? Do they care that I documented the color, the consistency, and the amount of their diarrhea? No! They would rather I spend my time at their bedside, keeping them clean and fresh and dry. They would rather have me there, listening to their stories and seeing them for the human beings that they are: people who have lived lives and gone places and seen things and done things, people who have families and pets and grandchildren, homes in the mountains and cottages on lakes. People who are scared, insecure, in pain, helpless, vulnerable, and lonely. These are human beings that we as nurses are caring for, and yet, the system is teaching us not to do too much extra care because we just don't have the time. I know that establishing patterns in patients' vital signs, bowel/urinary habits, etc and the interventions required to manage all of those things are important...the patients wouldn't be in the hospital if it wasn't important, but how do we create time to provide the important things to manage their bodies, while still providing care for their souls and their minds? Obviously if everyone's health issues could be solved by listening to stories and holding hands, those of us in healthcare would all find ourselves out of a job, but in the hospital setting, the mental and emotional aspect of care is sorely lacking, and that matters. It does.  

Truthfully, it is tearing me apart. I've been thinking about leaving the hospital setting for a while now, and last night I had the thought, "Well, who is going to be sweet to the little old ladies if I leave? Who is going to take my place?" That might sound like hubris to you, but I'm good at what I do. I know that. And it's not just because I've been a nurse for nearly 21 years, it's because I like people. I love people. I love getting that grumpy little old man to smile, I live for the moments when a patient tells me that they can't, and I show them that they can. I love holding hands, brushing hair, giving back rubs, rubbing lotion into dry skin, and sitting next to the bed, listening to a story. I absolutely love making them laugh...there is too little laughter in the hospital, and there needs to be more. I wish I had more time to do all of those things, because while they might sound trivial to some, they are so important to that patient lying there in the bed. On an average night, I find that making sure I've documented everything properly stresses me out more than the patient care does. God forbid I spend 5 minutes talking a patient through a scary moment of chest pain, because those are 5 minutes that are going to take away from the 15 minutes (at a minimum) that I'm going to spend documenting when the chest pain started, what I did, who I called, what they ordered, what medications I gave, what the follow-up was...all while simultaneously managing the care of my other patients. And yes, documentation is important, but it shouldn't be the most important. Caring for patients and making them feel safe and seen and heard should be the most important. 

Most days I come home from work defeated, feeling like I didn't make a difference. That I didn't have the time to make a difference because I was too busy documenting what I did to correct the "differences." I hope that my patients would tell you otherwise, but who is there to listen? Administrators are too busy running diagnostics to see which medications were given late, so they can post it on a spreadsheet in the employee bathroom for all to see with absolutely no context. And that's the thing...we get taken to task for things that happen in the hospital and no one bothers to ask us for context. To document all the context would take even more of my time away from the patient, so instead of documenting that I was sitting at the bedside of a patient, reassuring them that everything is going to be okay, that I'm going to do everything I can to get them a good night's rest and that I'll be there whenever they need me, the med is just given late. Sorry, not sorry...patient care comes first.  Someone getting a stool softener 15 minutes past the arbitrary administration time (seriously, who takes bowel care meds at 10pm anyway??) is hardly cause for public shaming in the restroom setting.

Long story short, I feel like I can't be the nurse I want to be because I'm too busy charting and bending over backwards to appease management when my energy and focus should be spent appeasing my patients. My shifts are consumed with phrases like, "Cover your ass!" and "If it isn't documented, it isn't done!" How about maybe we give nurses the benefit of the doubt and get rid of the notions that nurses are maliciously neglecting their patients? I know that there are nurses out there who probably shouldn't be in healthcare...in all my years as a nurse, I've come across a few who I would never, ever allow to lay a finger on a loved one of mine, but I truly think that those nurses are in the minority, and that most of us have the best of intentions, and that the system is failing both us and our patients. 

When I think about that Senator who made the quip about nurses playing cards at the nurses' station, I'd love to shove a deck of cards down her throat and up her ass and tell her to shuffle them. What an ignorant ass, and clearly someone who has spent zero time in the hospital setting, or doing any sort of research whatsoever into hospital culture before spewing her nonsense. The sad thing is, it isn't just she who feels that way. When a person walks onto a nursing unit and sees us all engrossed in our computers, (assuming we're not in a patient room), it literally looks like we're doing nothing, like we're surfing the web or shopping on Amazon. If the average person knew how much time I spend documenting on my computer versus the amount of time I spend providing patient care, I think they'd be shocked...it is in no way equal, nor is it favored towards patient care. When families call and try to get an update and it takes me too long to get to the phone, I'm not typically met with understanding, I'm met with hostility and impatience, as if I'm being neglectful to both them and their family member. When I gently try to impress upon them how busy I am, rarely am I met with sympathy or compassion. Maybe the next time I get push-back from a family member I will inform them that the administration doesn't find it prudent to provide us with sufficient staff to meet the needs of both the patients in the hospital and their family members outside of it, so I have to pick one. I have to pick the patient...I will always pick the patient.  

When I hear people in conversation making disparaging comments about nurses, I want to scream. I am smart! I have good instincts! I am college educated! And yes, I did my fair share of partying in college, but I did it alongside my fellow nurses and their now-husbands, who are engineers, some of whom are making life-saving cardiac pacemakers. We turned out just fine, and we're good at what we do. It is so hard to be a family member sitting at the bedside, thinking that everything is taking too long; trust me, I know. Imagine being  both a nurse and a family member sitting at the bedside, critiquing and questioning and wondering why everything is taking so long. I know why things take so long, and even I get frustrated. Healthcare is a messed up institution, and we can go so much farther by supporting each other, even when it's hard. I wish that things were different...I know they could be, but they're not and I think we're too far gone to turn the ship at this point. Healthcare is a business that profits off of human suffering...that's the unfortunate truth. I'm just here trying to do my best, one little old lady at a time.

So there it is. I wish I could say that I still love being a nurse, that it still fills my cup and that professionally, it's all I'll ever want to do. But I can't say that. The truth is, I do love being nurse, I just don't love the way I'm required to do it right now. I'm making some moves, putting out some ideas, and talking to a lot of people from different walks of life trying to figure out how and where I can do the most good, both for myself and for my patients. At 43 years old it's hard to think about starting over, but I think it's time. I still have so much of myself to give to the patients of the world, but I'm realizing that maybe the hospital setting isn't the best place for me mentally, physically, or emotionally to give it. 

Love to all my nurses and fellow healthcare workers out there...the ones who are just starting out and who are still excited...keep on rocking it, but please don't forget to take care of yourselves too. To all my fellow burnouts...I see you, I feel you, I'm here for you, I support you. For all the admins out there who are personally affronted by the way you're presented here, well, this is how you're seen by your subordinates. Do you care? Do better for your patients, your staff, and the community in general. We're all in this together...at least we should be. 

I'm okay, really, I am. It's just been a moment. This too, shall pass. Love to you all. Be gentle with yourselves.