To achieve a clinical ladder promotion, nurses had to be in good standing at the hospital. Pines had a policy prohibiting nurses who made one patient identification error from applying for any type of promotion that year. Two mistakes in a twelve-month period and the nurse would be fired. Juliette knew she hadn’t made any notable mistakes, but she wanted to make sure she qualified before she put in the work.

“There’s nothing specific that I know of,” Priscilla told her. As the nursing director, she would have heard if Juliette had committed an infraction or received complaints about her work. “But you have six tardies and you need to watch it.”

“I will, I’ll be careful. But I’m okay to apply?” Juliette asked.

“Absolutely.”

Juliette punched a fist into the air. She was so exuberant that she went to tell Charlene. “Charlene, guess what! I’m applying for clinical four and I’m going to make a really strong effort.”

“I’m not sure you can,” Charlene said. “I’ve got everyone’s tardies and stay-lates printed out. I’m highlighting all of them. It’s a pet project of mine.” Charlene didn’t want nurses to stay later than their shift because she didn’t want to pay them unnecessary overtime. She smiled. “So we’ll see.”

Juliette deflated.

SAM

  CITYCENTER MEDICAL, February

Everyone at Citycenter was talking about the surprise inspection. The nurses were ecstatic and relieved that The Joint Commission had stepped in. One nurse told Sam that during an interview, she had admitted to the TJC investigator that she was uncomfortable sharing what she really wanted to say. The investigator held up a thick stack of papers to indicate how many others had spoken freely and replied, “You have nothing to worry about.”

The day after the inspection, Victoria sent a mass email to say she was transferring to another department to pursue other opportunities. A nursing administrator would take over as interim ER director. Victoria’s words didn’t fool the nurses. Everyone knew the real reason she had been transferred. A nurse who was friendly with Sam included her in a Facebook message to several coworkers that said only, “Ding dong, the witch is dead.”

Once Victoria left, the changes came quickly. The hospital immediately hired more than a dozen new nurses and instituted a bonus policy for nurses who worked extra shifts. The ER now would have mandatory daily checklists that monitored code carts and supplies. Maintenance workers deep-cleaned every room, waxed the floors, and painted the walls. Reportedly during the inspection, one of the surveyors had asked to see a room considered to be clean. A nurse led him to an empty room that was ready to receive an incoming ambulance patient. The surveyor saw blood splattered on the wall, empty bags hanging from IV poles, used blood culture bottles, capped IV needles on the floor, and trash on the counter. When administrators later dispatched multiple housekeepers to that room, it took ten hours to clean it to infection control standards.

Sam was pleasantly surprised by the interim ER director, who seemed willing to listen to the staff. On her first day, she changed Sam’s status to “weekend alternative”: For $10 more per hour, Sam would work weekends plus one weeknight per week, with one weekend off per month. She had been trying to get weekend alternative for ages, because, she rationalized, “if I’m going to be working in hell I’d at least have a regular schedule doing it.” Her previous discussions with HR and her supervisors had gone nowhere. The new director made it happen in one day.

The director quickly gained respect from the ER staff because she was willing to do whatever was necessary to help the department. She came in on weekends and cleaned stretchers. She put on scrubs and transported patients. “She is terrific,” Sam said. “It’s great to have someone in an authority position supporting us like she does. It makes a tremendous difference.”

Sam was sitting at the nurses station with William when Dr. Spiros stopped five feet away from them to talk to another nurse. William waggled his eyebrows toward Dr. Spiros, whose back was turned, then mouthed at Sam, “Your boyfriend’s here.”

Sam’s gray eyes narrowed behind her glasses. Angrily blushing, she whispered, “You can be done with the comments and the looks because there’s nothing going on.”

By now, Sam could discuss patient care with Dr. Spiros, but she still felt too awkward to say anything more to him than was professionally necessary. It was weird enough that she knew what he looked like when he wasn’t in scrubs and that she had been inside his home, let alone that they’d had an almost-but-didn’t relationship. At work, rather than waver between calling him Dr. Spiros or Dimitri, she tried not to use his name at all.

Sam didn’t mind being single, though it would have been helpful to have an extra ally in the hospital. She could admit to herself that she had a crush on William, but knowing he had a girlfriend, she would never act on her feelings. She was content to appreciate their growing friendship. Despite his teasing, Sam enjoyed working with William, and not only because he was an excellent, sure-handed nurse. He respected her and he made her feel appreciated. Sometimes he called her hospital cell phone just to say hi or to ask if she needed help.

One night, the charge nurse was doling out assignments and put William on Zone 1. In front of the staff, she asked him who he wanted to work with that night.

“Sam,” he said.

As Sam smiled to herself, proud and touched that William had chosen her out of all of the other nurses, she looked up and saw CeeCee glaring at her.

It was obvious that CeeCee assumed that she and William were close. Certainly, he was nice to her. CeeCee was always badgering him with social requests: “William, let’s do a group bike trip!” “William, come on the ferry with us this weekend!” Sam knew that William was warm to everybody. He had told Sam that he joined the young nurses’ social outings so that they would continue to feel comfortable seeking his help at work. He didn’t want them to think that because he was often the charge nurse, he was unapproachable.

Sam remembered when, as a nursing student, nearly everyone her senior seemed unapproachable to her. That had changed as she had gained experience treating patients and become accustomed to her colleagues. Without a doubt, William had played a major role in her growth, as a teacher and as a friend. He felt like a safety net, especially, as Sam put it, “when the place is so unsafe that I could lose my license.”

Now Sam was growing more confident day by day. She had a good general sense of the ER, knowing where the sick patients were even if they weren’t hers. She had learned how to get other people to work more efficiently with her; for example, if she needed lab results urgently, instead of inputting a lab request into the computer, she wrote it on a paper lab form, brought it down to the lab herself, and said, “We’ve done these labs. I need you to run them, please.”

One night medics brought in a 58-year-old trauma patient who had driven his car into a tree. He was awake and alert, though he didn’t remember the accident. While two residents examined the patient, Sam, as the recording nurse, stood in the back of the room taking notes. Shirley, the ER nurse practitioner, stood next to her.

As Sam watched the heart monitor, she noticed that the patient was having several premature ventricular contractions, extra heartbeats that disrupt the regular heart rhythm. While some PVCs are normal, the patient had many more than the average person. The patient’s nurse was busy drawing blood and the residents were engrossed in their assessment.

“Hey, Shirley, our buddy here is throwing a lot of PVCs,” Sam told the NP.

Shirley watched the monitor. “You’re absolutely right,” she said, then addressed the other nurse. “Let’s add magnesium levels to the labs and get a cardiology consult.”