Molly found Sarah, the charge nurse. “Where’s his sitter?” she asked.

“There isn’t one,” Sarah said.

“But TJC recommends a sitter for patients in four-point restraints,” Molly pointed out.

Sarah shrugged. “We tie people down here all the time. With the patients we get, we prefer it that way.”

The staff was generally competent and dedicated but spread so thin that they couldn’t consistently provide quality healthcare. Citycenter, where Molly was scheduled for several upcoming shifts, was in even worse shape than she had expected.

The Fertility Clinic

The next day, Molly was off from work so that she could attend her first appointment at the fertility clinic. The nurse at the desk showed her the list of tests the clinic wanted for the initial blood draw. Molly scanned it, concerned. Her husband’s health insurance covered only up to $10,000 of certain fertility treatments and didn’t cover in vitro fertilization. As a nurse, Molly typically made about $60,000 a year before taxes. Trey’s police officer salary brought in $77,000 before taxes. They were trying to save for a down payment on a house, but too many out-of-pocket fertility treatment costs would wipe out their savings.

Molly crossed the varicella, rubella, HIV, and hepatitis C tests off the list. She had been tested for all of them within the last two years.

“Why are these crossed out?” the nurse asked.

“I had those tests performed less than two years ago and I only get a certain amount of insurance funds, so I’d like to save money on tests that have been performed recently,” Molly said. The nurse shook her head and led Molly to the back room to draw blood.

The nurse frowned as she poked Molly. “You’re as tight with your blood as you are with your money,” she carped.

Molly ignored the dig. “I didn’t know what two of the tests on that list were. Could you tell me?”

The woman didn’t answer. After the draw, Molly watched the nurse label the tubes. She pointed. “These two here—what are those?”

“I can’t tell you,” the nurse said. She didn’t even look at Molly.

“Because you don’t know or because you aren’t allowed?” Molly asked, confused.

“Our policy is to not tell people.”

“That doesn’t make sense,” Molly said. “I’m paying for these. These are elective tests.”

“You’re a nurse. You understand,” the nurse said.

“No, I don’t understand. When my patients ask what a test is for, I tell them,” Molly said. The woman glowered at her and left the room.

Safe in the elevator hallway, Molly composed herself. Struggling with infertility was difficult enough; why did the clinic have to make the process so unpleasant? Typically, she chose her doctors based on their bedside manner, but she had selected her fertility clinic because of its success rates. Patients here dealt mostly with the nurses until the actual procedures. Still, she couldn’t help yearning for “someone to make eye contact, to have some inflection in their voice that shows they care about me, not just keeping their profits up,” as she phrased it. “At a fertility clinic, a little warm fuzzy would go a long way.”

That experience, and subsequent visits to the clinic, left Molly feeling like a number. On no occasion did clinic doctors or nurses introduce themselves before performing a procedure. As a result, Molly vowed to introduce herself clearly to each of her patients, to show them her badge, and to explain her role. “People aren’t taking the three seconds to say, ‘Hi, I’m Sandy and I’ll be doing a transvaginal ultrasound on you today,’ ” Molly said. “As a healthcare worker, I’m generally less sensitive to that type of stuff, but the fertility experience is making me feel horrible. My patients see me during an emergency. They’re probably more scared than someone going in for routine fertility testing. I will do a better job of putting ER patients at ease.”

Chapter 2

Crossing Doctor-Nurse Lines

:

How the Sexy-Nurse Stereotype Affects Relationships with Doctors and Patients

“I will not be ashamed to say ‘I know not,’ nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.”

—Physicians’ Hippocratic Oath

“The intimate nature of nursing care, the involvement of nurses in important and sometimes highly stressful life events, and the mutual dependence of colleagues working in close concert all present the potential for blurring of limits to professional relationships.”

—Code of Ethics for Nurses, Provision 2.4

“Lots of hot residents and nurses rush off to have quickie sex in utility closets during night shifts.”

—a nurse practitioner in Virginia

MOLLY

  September

Academy Hospital

During Molly’s third week at Academy, a patient arrived at the ER already dead. Molly asked the charge nurse what kind of paperwork she needed to fill out.

The nurse, who was about 22, looked perplexed. “Honestly, I’ve never had a dead patient so I don’t know. Can you ask someone else? I’m not getting patients out of here quickly enough. It’s just too overwhelming.”

Molly tried not to show her surprise. How are you in charge without ever having seen a dead body? she wondered. Twenty-two-year-olds have no business being in charge of an ER.

The patient load would have been considered a breeze at Pines; Molly had already come to think of Academy as easy money. Nurses here typically had no more than four patients, few of the patients were critically ill, and patients spent no more than thirty minutes in the waiting room.

Molly wondered whether a recent shift in nurse training contributed to the girl’s inexperience. Traditionally, new nurses first had to work on the medical surgery floor to gain experience before moving to the ER and other critical care areas. The nationwide nursing shortage (or in some cases, short staffing) instead punted grads into more difficult areas of the hospital. Nurses were starting their career in the ER, OR, or ICU. “At Academy, some of the baby nurses don’t know what they don’t know,” Molly said. “And there are med students and new doctors who are also on the learning curve. At Pines, there were plenty of times that a doctor put in a wrong medication order, and an experienced nurse was there to say, ‘Hmm, that doesn’t seem right.’ But not at Academy. There’s potential for big mistakes with this young staff.”

Many of the doctors at Academy were egotistical, but Dr. Cynthia Baron took the cake. Dr. Bitch, as Molly referred to her privately, was a resident who resembled Malibu Barbie, swishing her impeccably blown-out hair as she sauntered down the halls. She rarely deigned to talk to nurses unless she was angry with them or needed something, in which case she treated them like preschoolers: “Hi, pumpkin, can you do me a teensy favor? Thaaanks.”

One day, a well-dressed 88-year-old woman came into the ER. Molly was prepping her assigned room when two nurses practically carried the wheelchair in, rickshaw-style, one tipping the chair back and the other holding the woman’s kicking feet to the leg rests to prevent the woman from pitching forward. Molly was horrified. Do you really need to do that to this poor little old lady? she thought.

“I just want to go home!” the patient cried, thrashing about as the nurses set the wheelchair next to the bed. “I don’t want your help!” She tried to walk out of the room, but she was unsteady, and the nurses, assuming the woman was suffering from dementia, returned her to the chair.

Molly, the patient’s primary nurse, quietly observed her. Dr. Baron poked her head into the room, saw the commotion, immediately ordered antipsychotic drugs for the patient, and left. Hospitals could hold a patient for seventy-two hours following an assessment, but Dr. Baron hadn’t evaluated the patient at all; she based the order on the patient’s initial behavior alone.