This discrepancy in care frustrates nurses, who observe firsthand when patients with similar health concerns have extremely different experiences. “Some people abuse the system and take up more of the doctor’s time, utilizing more resources and even taking up ICU beds. Sometimes they even dictate staying in the ICU extra days,” said a Washington, DC, pediatric nurse. “It doesn’t seem fair that one family is having a cushy experience, while the other is sleeping upright in a chair crammed in the corner just because they aren’t famous.”
We know you better than your doctor does.
Nurses want patients to remember that from the moment patients enter a hospital to the moment they leave, nurses—not doctors—will be more intimately involved with their care. “The doctor is at your bedside for all of three minutes unless you’re getting intubated or coding. The nurse is the one rapidly assessing you at the door, immediately determining what interventions need to be made, so that when the doctor does come into the room he has something more intelligent to say than, ‘Well, we’re going to get some labs and an X-ray,’ ” a North Carolina ER nurse said. “I get you undressed, on the monitor, cleaned up if needed. I will wash the blood and vomit out of your hair, and not gag or make you feel embarrassed that you’re sick. I’m the one who will go to the doctor and tell them you are having nausea, pain, or a neuro status change because suddenly you think it’s 1988. That will be the reason that you get a head CT, and we find a brain bleed and contact the neurosurgeon. And then I will be at your bedside for the next three hours while we wait, reassuring your mother. You will hardly ever see the doctor. You will always see the nurse.”
Sometimes we are forced to stay at work against our will.
Nurses told me about regularly being expected to stay 30 minutes, an hour, or 90 minutes past the end of their shift without pay. But inclement weather is an entirely different beast. “Our last snowstorm, they wouldn’t release the nurses until enough of the next shift made it in to cover the hospital,” said a Midwestern nurse. “During these times, we work, sleep, and shower at the hospital just to work another couple of shifts. If we can’t make it in, they’ll get us with a snowmobile if they have to. They’ve had army reservists drive out in their Hummers to get us. They make us stay against our will. Sucks when you have kids at home or are a single mom without a strong support system.”
Nurses don’t necessarily choose to work fourteen- to sixteen-hour shifts. “When nurses have attempted to refuse this overtime, we have been told this would be considered ‘patient abandonment.’ Nurses are not willing to abandon our patients,” an Ontario nurse told the Canadian Federation of Nurses Unions.
Don’t get sick on weekends, either.
Depending on the hospital, weekends and nights can be riskier for patients, some nurses said. “Half of this hospital is unavailable during those hours. A STAT echocardiogram isn’t always STAT,” said a Midwestern nurse. “There isn’t maintenance available, so you have to wait for Monday to get things fixed, which can be frustrating when it’s a procedure light that could help you out, or you have to move a patient because the monitor broke. If you run out of supplies, you have to make do until Monday.”
If a hospital’s technicians don’t work weekends, nurses might have to send special labs to outside techs, which can delay a patient’s care. Because some organizations’ housekeeping services are reduced on weekends, nurses have to take time away from patients to clean patient rooms or hunt down equipment themselves. If a hospital needs to work on the computers or the water system, the outages can also cause increased wait times. “It’s risky sometimes because of the staffing issues. We can’t staff for the what-ifs,” said a NICU nurse. “At night, our NICU nurses go to ER and Peds to draw labs and start IVs. That takes nurses off our unit and we’re temporarily understaffed. If there is a code or a delivery when this happens, it can be bad.”
Sometimes we put alcohol in your feeding tube.
If a patient with a history of alcohol abuse needs open heart surgery, a Maryland Cardiac Surgical ICU nurse said, he or she might get alcohol (supplied by the pharmacy) with hospital meals or through a feeding tube to prevent alcohol withdrawal symptoms such as elevated heart rate, anxiety, and shaking. A nurse in an Oklahoma cardiac unit who has administered this treatment to a patient said that, on physician’s orders, the pharmacy brought 60 ml of bourbon each night to the nurse and watched her pour it down a nasogastric tube. While this method is considered “old school”—hospitals more often give patients Ativan—“it is funny to say that you gave your patient a shot of bourbon as a medication order,” the nurse said.
That’s going in your chart.
Ever wonder what nurses are writing in your patient chart? If you say something offensive or off-the-wall, nurses chart it. If your family member creates issues, that goes in the chart, too. “I always chart when a patient is difficult or belligerent. I keep it objective and write direct quotes; it’s funny to have to type ‘Fuck you, bitch’ in medical documentation,” Molly said. Nurses chart everything because if a patient later sues the hospital, the evidence can diminish the patient’s credibility. Along those lines, Molly added, “If you claim to know someone, be someone, or say you’re going to sue, it doesn’t increase your chances of getting better service.”
You might not need the surgery your doctor says you need.
“Sadly, doctors and doctors’ offices bully people into having tests and procedures they don’t really need, especially the elderly,” said a Tennessee travel nurse. Similarly, “If I could talk to my patients before open heart surgery, I would probably advise thirty percent of them not to have surgery,” said a New York nurse. “Our fee-for-service healthcare system incentivizes doctors and hospitals to advise aggressive, high-cost treatments and procedures. Doctors undersell how much rehabilitation the successful recovery from heart surgery requires. Most patients tell me they didn’t know the recovery would be as difficult as it is. Every time I see patients over eighty-five opt for an aortic valve surgery because they were becoming short of breath on exertion, I scratch my head because many of these high-risk patients will not get back all the faculties they had before the surgery, and some won’t even make it out of the hospital.”
We cry over you.
They might not do it in front of patients, but nurses do cry about the people they treat, whether with patients’ families or on their own. “Because I’m a burly man, [people think] I am not affected as much, but I am,” said an Oregon murse. “Sometimes I cry on the way home from work.”
Some stories are too sad for even the most composed nurses to bottle away until after the shift. Nurses in Kansas, California, and other states told me about child abuse cases that led them to sob in the break room. A young Illinois nurse was taking care of a woman in her nineties and learned that “even when a patient can’t respond and their eyes are closed, they can probably still hear you.” While the nurse was talking to the patient, her preceptor laughed at her. “She can’t hear you and she’ll never open her eyes again. Stop wasting your time. We have a lot of other patients to get to,” she said and walked out the door. The nurse took the patient’s hand, squeezed it, and said, “I believe that you can still hear me, and I promise to take good care of you.” The woman lightly squeezed back. “I knew she heard me and I lost it right there. Even when patients may not be there all the way, they are still someone’s mother, father, sister, or friend, and deserve to be treated with respect,” the nurse said.