Sometimes we goof around with the medical equipment.
When a department is slow (more likely on the night shift), hospital staff members have several props with which to entertain themselves. Nurses told me about wheelchair-racing down the hall, playing darts with needle syringes and rubber-glove balloons, having squirt gun fights with saline syringes, and bowling with (empty, clean) urinal jugs for pins. A Louisiana nurse and her coworkers do lunges down the hall at three in the morning to stay awake during the night shift. On slow nights in a Virginia ER, nurses used to pull clothes out of the donation box and have runway fashion shows. “The little things you do with coworkers can make your shift exponentially better,” said a Minnesota travel nurse. “We listen to music all night, do the wobble wit (a group dance like the electric slide) at the nurses station, or have catwalk competitions down hospital hallways.”
We gossip about our patients . . . when they deserve it.
Plenty of nurses confessed that they gossip about their patients, although they take care to respect the patients who respect them. “If there’s something really different, salacious, or disgusting, we love to tell our coworkers,” said a Washington State nurse. One story involved a mentally disturbed patient who went into the bathroom, cut off his penis, and threw it across the waiting room. Most patients don’t have to worry, though. A Maryland cardiovascular ICU nurse said, “The funniest stories involve the crazy patient who did something with poop.”
We might use a larger needle than necessary.
In a practice that is not often discussed in the medical profession, some nurses occasionally use larger needles than necessary to “punish” obnoxious patients, as Molly did with the drug seeker.
Sometimes we break the rules.
If breaking a rule will help a patient or protect a colleague, some nurses will break it. A Midwestern nurse at a hospital that refuses to give nurses overtime has clocked out before she was finished so she wouldn’t get written up for working overtime, and then risked being penalized anyway by returning to the unit to care for her patients for free. “That used to never happen, to work in a place where you’re afraid to make a mistake or you’ll be fired,” she said. “Overstaffing the next shift is a mistake, ordering too many or too little supplies is a mistake, not answering the phone within the first few rings is a mistake.”
In an Indiana NICU, “personal interaction is against policy,” a nurse said. Nevertheless, “When the kids are hurting or dying and the parents aren’t there, we will sing, kiss, rock, and love on the babies. We pull the curtain for privacy. You can’t help but smooch their tiny feet. That spot behind their neck is especially a sweet place to nuzzle. They love it.”
Sometimes we lie to you.
Nurses occasionally lie to protect a patient’s feelings or to make him feel more comfortable. A New York nurse told Reader’s Digest, “When you ask me, ‘Have you ever done this before?’ I’ll always say yes. Even if I haven’t.”
“We usually know the results of your tests before the doctors talk to you. We can tell when a loved one will have a bad neurological outcome but can’t tell you,” a Virginia pediatric nurse said. “We usually know what we would do, but can’t tell you what it is. We have to give you information in a nonbiased fashion so that you can make those decisions, even if we are dying to tell you what to do.” Even if patients specifically ask nurses, “What would you do in my situation?” some healthcare institutions have told nurses they cannot answer directly.
We are gross.
Nurses use toilet humor and are known for telling disgusting medical stories over meals (to the chagrin of non-nurse dining companions). And when they are out in public, “we are secretly looking at people’s arms to determine where we would start an IV,” an Arizona nurse said. “Sometimes if I’m out with a group of nurses, we’re like, ‘Wow, look at those veins. I could hit those from across the room.’”
At Pines, medics once brought in a 90-year-old man who had passed out after choking. A nurse grabbed a pair of forceps and pulled out a piece of chicken the size of half a deck of cards from his trachea. By then the man had gone too long without oxygen. Once his time of death was announced, Molly helped clean him up and tidied the room. “Then I washed my hands and immediately went and ate my lunch: leftover chicken!” she said. “Nurses are gross.”
Your DNR might be ignored.
Nurses in several states confirmed Dr. Clark Preston’s statement to Juliette that a family member can override a DNR, or Do Not Resuscitate order. While some nurses said that at their hospital, patients with signed, current DNRs are not resuscitated, several nurses told me that saving patients with DNRs “happens all the time.” The most common scenario occurs when an elderly or chronically ill patient with a DNR requires resuscitation and a family member tells the medical team to “do everything you can” to save the patient. Particularly if the family member has power of attorney (POA), nurses said he can change the plan of care.
“Theoretically we’re supposed to honor the DNR, but oftentimes the family will want the patient treated because they see the DNR as ‘giving up.’ We tell the families that the DNR means the patient didn’t want to be worked on if they’re in this situation. If the family tells us to do everything, though, then usually we have to, because the POA has the legal right to make medical decisions even if it overrides the DNR. Even if there isn’t a POA present, the next of kin still have the right to make decisions,” said a travel ER nurse based in Texas. “Families want us to ‘do everything,’ and if we let the patient die, we’re accused of killing them by refusing care. Because a POA can decide for the patient, it gets tricky if we try to honor the DNR. Basically it’s a lose-lose scenario.”
Medical providers can override a DNR because of a family dispute “and not really risk punishment,” said Arthur Caplan, Division of Medical Ethics director at NYU Langone Medical Center. If a DNR is vague or was filled out many years ago, physicians might doubt whether they can trust the document. “Think of a DNR as something that tells you a person’s wishes, but it’s not a binding order. Sometimes it can’t be binding because it’s confusing. Sometimes the family’s screaming a lot and we don’t want to cross swords with them,” Caplan said. “Sometimes the nurses don’t feel involved in these discussions with the physicians and don’t know why they decided not to treat further, so the nurses line up with the family. I have seen nurses fighting with each other about a DNR.”
It’s unlikely that the medical team will be penalized for overriding a DNR written with a patient’s consent, Caplan said, “because if you’re trying to keep someone alive, no lawyer will take that case.” If the medical team abides by the DNR, despite the family pushing them to override it, the family could sue, but would most likely lose. However, “Hospitals are afraid of being sued unnecessarily, so they tend to do what families want. Usually the patient with a DNR is pretty sick, probably not even talking. The family’s talking a lot. The easier route is to just do what they want. Forget a lawsuit; hospitals just don’t want to get into a fight. There’s a lot of deference to families who make a lot of noise, particularly families who are rich. I’m not sure every family counts the same.”
If there is time, hospital ethics committees can review cases in gray areas, such as when family members disagree. A New Mexico travel nurse said that physical fights break out among families over this issue. “People get desperate at the end,” said a California travel nurse.