The cool nurses hung out together exclusively, which was fine with Molly, but the techs wanted to help only the cool nurses, which was not fine. Molly happened to be charting at the nurses station next to Lena, the clique leader. Whenever another “cool nurse” walked by, Lena stopped her. “Hey, we’re going to happy hour tonight, but don’t tell anyone, because I only want the cool people there,” Lena would say.

Molly shook her head in disbelief. After six cool nurses—and fifteen apparently uncool nurses—passed by, Lena turned to Molly. “I guess you can come, too”—she paused—“if you want.”

At first Molly was astonished by the nurse’s immaturity. She had to remind herself that these were girls, not women, and that they weren’t that many years out of high school. She was constantly amazed by the ways that some of these young nurses could act like teenagers one moment, then flip a switch and impassively handle high-pressure patient situations the next. ERs could hire new grads to work on codes when they were doing keg stands a month ago. Molly decided not to call the nurse out on her behavior because it didn’t affect her, unlike the charge nurse’s attitude toward agency nurses. “I already have plans,” she said. She would not return to Riverport again.

Molly had heard that some staff nurses treated agency nurses poorly, but she was surprised now that it was happening to her. “If the agency nurses weren’t there, the staff nurses would have a much higher patient ratio,” she explained. “We make their job easier, but they’re rude and unfair.” Another agency nurse had told Molly that one day she had arrived at an ER that had a total of seven patients. The charge nurse assigned her all seven. When the nurse asked why, the charge nurse said, “You’re agency. You’re getting paid more than us. You can handle it.”

Some hospital administrators were partly to blame for creating an us-versus-them mentality. During October’s Emergency Nurses week, one of two nurse appreciation weeks during the year (the other is National Nurses Week in May), hospitals usually gave nurses tokens of appreciation. At an Academy Hospital staff meeting Molly was required to attend, the ER manager had given plush blankets with Academy’s logo to every nurse in the room except Molly. “Sorry, these blankets are for staff,” she said. How easy would it have been to give out one extra blanket instead of making me feel like I don’t contribute to the department? Molly thought.

Molly cared less about the gifts than the sentiment. Academy supervisors had repeatedly told her that she was a valuable nurse and had asked her to pick up extra shifts. “I probably would’ve used it as a dog blanket anyway. But really, right in front of me? ‘You’re agency, so we can’t give you one?’” she groused to a friend. “Why are you going to make people feel excluded when we’re there to help you? All of the agency people are experienced nurses. Why are y’all trying to create animosity between the two?”

Citycenter Medical

By the time Molly finished an exhausting shift at Citycenter, 110 patients waited in the ER, more than many ERs saw in an entire day. That night, Molly vented to Trey about Citycenter. He listened patiently to her, like he always did.

“So stop working there,” he said. As usual, a man of few words.

Molly paused for a moment to reflect. Why wouldn’t she simply stop working at Citycenter? Academy was easier (though less interesting). “I don’t want this job to beat me,” she said. “I don’t want anyone to think I can’t handle it. I don’t think any job is too hard for me, and I don’t want to walk away.”

“If you’re getting burned out, just work a day or two every once in a while,” Trey suggested. “Lowering your stress level might make it easier to get pregnant anyway.”

“That’s true, but I’m not stressed. I’m just angry. And full-time Citycenter nurses are putting themselves through those conditions every single day. If I walk away, I’ll feel like they are stronger nurses than me.”

“You took the agency jobs to see if there are better hospitals than Pines,” Trey said, affectionately squeezing her shoulder. As he left the room, he added, “Maybe there aren’t.”

The next day, Molly had just given report to a night-shift nurse when an ambulance brought in a little old lady who had fallen. She had been assigned to a room, but the Citycenter nurses were swamped with other patients.

As Molly passed by the woman’s bed, she noticed that the woman had urinated on herself. Molly was weary and off the clock, but she knew that if she didn’t help the patient, she would be sitting in wet clothes for hours. Molly worked up a sweat as she struggled to change the woman’s clothes.

The woman was grateful. She said sweetly, “I think anyone who is an ER nurse must really want to be an ER nurse. It’s such a difficult job.”

“I think so, too!” Molly said.

On her way home that night, Molly reflected that the woman was correct. “As much as I complain about all the B.S., if I didn’t want to do it, there are lots of other options in nursing. But I choose the ER. There’s a sense of satisfaction that comes with ‘fixing’ people,” she said. “In so many areas of healthcare, people have long-term treatment for things they may not recover from. In emergency medicine, a person comes in with crushing chest pain, gets diagnosed with a heart attack, gets meds, gets shipped to the cardiac catheterization lab, and gets fixed. A person comes in with abdominal pain, gets diagnosed with appendicitis, goes to the OR, and gets fixed. I need to remember that I chose this specialty. The reality is healthcare is broken. I need to figure out how to either let it go or decide how I can contribute to fixing it.”

Molly had no desire to be a floor nurse. At every hospital where she had worked, there was a rivalry between the ER and the other nursing departments. “We think they’re lazy and they think we’re bitches,” Molly said. One of the most frequent complaints ER nurses had against floor nurses was that floor nurses tried to avoid getting new patients as shift change approached.

Many floor nurses made excuses to Molly and her colleagues for why they couldn’t take a patient at shift change. “The room’s not clean” was one of them. More than once, Molly had gone upstairs to the floor, found the room to be clean, and called the nurse’s bluff. Another favorite was “There isn’t a bed in the room,” which meant housekeeping would have to bring up a bed. When one floor nurse used this excuse, Molly discovered that the nurse herself had pulled the bed into the hallway to avoid getting a new patient when she wanted to leave work.

During Molly’s next Citycenter shift, she called the medical/surgical floor to give report on a patient. The nurse who answered the phone said that the patient’s nurse-to-be was on break.

“Okay, I’ll give report to whoever is covering for her,” Molly said.

“There isn’t anyone covering,” the nurse said.

Right, Molly thought. This hospital is so fucked up. “So if one of her patients needed something while the nurse was at lunch, who would help them?”

“Me,” the nurse answered.

Molly didn’t miss a beat. “Okay, then you’re going to be getting a forty-four-year-old female admitting for intractable vomiting . . .”

LARA

  SOUTH GENERAL HOSPITAL, November

In the middle of the nurses station, two nurses were screaming at each other. Lynn, a young ER nurse, was trying to move a patient to the psychiatric department, but the patient’s blood sugar was high, at 200 mg/dL, when normal levels ranged from 70 to 100. Tashia, a psychiatric nurse who had been at the hospital for many years, wanted the patient’s blood sugar stabilized before moving the patient upstairs. She told Lynn, “No, we’re not taking her yet.”

“You’re a nurse. You can treat the blood sugar just like we can. We need her upstairs. She’s being admitted for treatment,” Lynn protested.