The Nurses
A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital
Alexandra Robbins
Workman Publishing
New York
To my family, past and present, with love
Contents
Prologue
Chapter 1
What It’s Really Like to be a Nurse:
The Joy and Heartbreak of the “Secret Club”
Chapter 2
Crossing Doctor-Nurse Lines:
How the Sexy-Nurse Stereotype Affects Relationships with Doctors and Patients
Chapter 3
Who Protects the Nurses?
Taking Care of People Who Punch You in the Face
Chapter 4
When Nurses Bully Nurses:
Hierarchies, Hazing, and Why They Eat Their Young
Chapter 5
Burnt to a Crisp:
How Nurses Cope–and Why Some Crack
Chapter 6
The Stepford Nurse:
How Hospitals Game the System for Patient “Satisfaction”
Chapter 7
The Code of Silence:
Painkillers, Gossip, and Other Temptations
Chapter 8
Don’t Get Sick in July:
Nurses’ Secrets–What Patients Need to Know About Their Hospitals and Their Health
Chapter 9
What Makes a Hero:
Why Nurses Do What They Do
Chapter 10
What You Can Do:
Advice and Inspiration for the Public, Patients, Families, Nurses, Aspiring Nurses, Managers, and Others
Wall of Heroes
Acknowledgments
Notes
Prologue
Four hospitals stand within a fifty-mile radius of a major American city. On the surface, they are as different from one another as fairy-tale sisters.
Pines Memorial Hospital is a pleasant-looking cream-colored building with a sixteen-story tower and broad, welcoming windows overlooking a quiet tree-lined suburban avenue. After decades of independence, the neighborhood’s favorite hospital was bought out by Westnorth, a large healthcare corporation, which is slowly diluting the local flavor. With 190 beds, Pines Memorial serves a highly educated, wealthy population with a large percentage of academics, retirees, and nursing home residents. Because it is close to a major highway, Pines’ emergency room, which has approximately 60,000 visits per year, often treats victims of major-impact car accidents. Nurses joke that the hospital should be called Highway Memorial, because the risks of the highway are far more relevant to the medical staff than the quiet red pine forests outside of town.
Several miles away, South General Hospital occupies a mostly gray edifice curved away from the road, as if to shield its inhabitants from the gang violence that occurs frequently nearby. The Level-1 trauma center—
designated as such because it has the resources to treat every stage of injury, from prevention through rehabilitation—has 300 beds to serve one of the most indigent areas outside the city. South General’s ER sees 95,000 ER patients annually. The reputation of “The South” is like that of the proverbial kid from the wrong side of the tracks, hoping to keep up with her peers, but unable to overcome the disadvantages of living on the poverty-stricken south side of town.
Forty-five minutes west, in a peaceful corner of the city, Academy Hospital, proud and prestigious, inhabits several white-pillared, brick structures that wind around courtyards and patios, reflecting the storied architecture of its surrounding university campus. With approximately 425 beds, Academy treats a ritzy demographic of young and middle-aged residents in the nearby million-dollar homes and the students at the elite university. The Academy ER treats fewer than 45,000 patients per year, partly because it simply does not have the building space to expand its emergency department walls.
And Citycenter Medical, a longtime teaching hospital, is split between two dusty beige high-rises, perhaps representative of its dual personalities: a stalwart institution with top-notch doctors and an ER so poorly managed it is considered dangerous by many of its own staff. A 390-bed Level-1 trauma center, Citycenter has an emergency department that is crumbling beneath the weight of the 85,000 annual patients it does not have enough nursing staff to treat properly. While Pines Memorial treats more blunt force, multisystem traumas because of the car accidents, Citycenter’s traumas are typically isolated injuries, such as gunshot wounds. Easily reached by public transportation and in the heart of a densely populated city, Citycenter is a destination of choice for homeless people, drug-seeking addicts, and the uninsured.
In each of these disparate institutions, pale blue curtains shroud pods of frightened people. In each, seasoned healers perform routine procedures and medical feats behind bleached sterile walls. And in each, tracking invisible undercurrents through hallway mazes, nurses connect doctors to patients, carrying out copious orders in synchronized steps, entwining themselves intimately in convalescents’ lives.
Chapter 1
What It’s Really Like to be a Nurse
:
The Joy and Heartbreak of the “Secret Club”
“Emergency nurses practice in an environment that has been called permanent whitewater, where constant change, challenge, and crisis are the reality. Amazing stories occur each day and some of these stories may never be acknowledged or written.”
—Emergency Nurses Association, Award Recognition Program
“In the hospital, we’re truly a family and we have fun together. ER nurses have the raunchiest jokes, foulest mouths, and grossest stories. Because we’re working in such close proximity there are always inappropriate jokes, comments, and teasing. Occasionally it escalates to a one-night stand between a nurse and doc, but mostly that happens off hospital grounds.”
—an East Coast travel nurse
“It’s like high school, except for the dying people.”
—Sam, a new ER nurse
MOLLY
PINES MEMORIAL, August
Molly raced toward the nurses station, dodging other fast-walking staff, weaving through stretchers lining the corridors. Traffic was stopped ahead; another nurse pushing a patient bed had gotten stuck because the halls were barely wide enough for two stretchers to pass each other. Molly had no time for this. No one did. The Pines Memorial ER was overloaded with patients, many of them moaning in pain or calling for the nurses who scurried through the brightly lit department.
After ten years as a nurse, three of them at Pines, Molly had learned to tune out the voices, and the cacophony of constant monitor chirps, high-pitched call-bell dings, and low-toned beeps of alarms from patients not her own. She didn’t even notice the smell anymore, a blend of cleaning spray, urine, and, depending on the number of intoxicated patients, alcohol.
Molly ducked under a stretcher, scooted in front of the traffic jam, and helped the nurse lift the bed slightly to extricate the wheels. When the nurse smiled gratefully, Molly flashed a thumbs-up and hustled to the station.
There, Erica, the senior charge nurse, caught her eye. “I’ve been trying to call a Code Purple for hours, but Charlene won’t budge!” Erica said. Friendly and smart, Erica struck just the right balance for a manager: She was firm but fair, and the nurses respected her. It was unusual for her to be rattled like this. A Code Purple—closing the ER to ambulances and rerouting patients to other hospitals—meant less profit for Pines Memorial, which would explain the administration’s resistance. But the ER desperately needed relief.