They are, for example, reporters. They discuss and document patient status, serving as the main point of contact for doctors, surgeons, therapists, social workers, and other specialists. They are watchmen, keeping vigil, meticulously monitoring vital signs, deciphering patients’ individual trends and patterns, painstakingly double-checking dosages and medications. They are detectives, investigating deviations, asking questions, listening carefully, searching for clues. They are warriors, called to serve at the first sign of outbreak, fighting infection, containing disease. They are gatekeepers, turning staff members away when patients need a break from procedures, a nap, or a moment to digest their circumstances. They are scientists, constantly learning, tackling sociology, psychology, physiology, anatomy, pharmacology, chemistry, microbiology. They are advocates, lobbying physicians for or against procedures, for pain assistance, for a few more minutes of time. They are teachers, educating people about their condition, demonstrating home healthcare to patients and parents: how to suction a tracheostomy, change an airway, inject a medication, breastfeed a newborn. They are the muscle, holding patients down to insert or remove tubes or needles, pushing people to get out of bed following surgery, breaking a sweat when performing CPR, lifting, moving, pushing, forcing, turning. They are confidantes, protectors, communicators, comforters, nurturers; easing fears, offering solace, cradling babies whose parents can’t be there, consoling loved ones who feel that all hope is gone. They are multitaskers: supporting, coordinating, and inhabiting all of these roles at once. And they are lionhearted diplomats, helping a patient die with dignity in one room, facilitating a recovery in the next, keeping their composure even when they are shaken to the core.
• • •
To examine what it is like to be a member of this secret club, I interviewed hundreds of nurses in the United States and several other countries. Essays based on their perspectives of the behind-the-scenes realities of nursing support stories that follow a year in the life of four ER nurses in an unnamed region of this country. Most of the people and hospitals in this book have pseudonyms and/or identifying details changed or omitted to protect their privacy. Some chronologies have been shifted.
The nurses I chose as main characters illustrate a variety of triumphs and struggles common in the profession. Confident, funny, and charmingly bossy, Molly is well loved by both patients and staff. When Pines Memorial’s anti-nurse policy changes lead her to quit her job, she signs with an agency instead. Molly has given herself one year to find a hospital that treats nurses and patients well enough that she would want to join its staff. At the same time, she begins fertility treatments that place her on the other side of the curtain.
Lara, an able, trustworthy, committed ER nurse at South General, continues to battle the temptations of prescription drugs that are preposterously easy to steal, and doesn’t know that the coming year will bring major events that could trigger her downfall. Juliette, an ER nurse at Pines, is a hard worker who doesn’t hesitate to advocate loudly for her patients even when it is not in her own best interest to do so. Her blunt outspokenness does not endear her to many of her colleagues. Subsequently, she feels unwelcome in a workplace where patients’ lives depend on collegiality and communication among staff. And at Citycenter Hospital, Sam is a new nurse, young and awkward, whose introversion can come across as unprofessional. Sam is discouraged by her doctors’ and administrators’ overall lack of respect for nurses, but she has to overcome other hurdles, including rumors about her promiscuity.
These four women and the other nurses I interviewed voice a rallying cry for their colleagues. Through their stories and others’, this book presents an extensively researched snapshot of a subculture as well as an investigation of the medical industry’s treatment of the nursing profession. Physicians grapple with some of the same problems as nurses, and countless skilled and compassionate doctors treat patients, solve medical mysteries, and save lives. Physicians’ voices are already heeded, however. This is not their story. As such, some doctors may be depicted negatively in the stories to follow, but this book does not intend to denigrate doctors, techs, or, for that matter, patients. It is meant to represent nurses’ perspectives and to celebrate them.
In doing so, this book does not romanticize the career. Nurses want the public to know the truth about nursing. It can be a difficult, exhausting, exasperating, and dangerous job in which they are often overworked and understaffed. But it is also joyous, rewarding, challenging, fascinating, exciting, and meaningful. Nurses want current and future patients and their families to know the healthcare secrets that can save their lives. And they want potential future nurses to know how deeply and passionately they love what they do. “Nursing is not a job. It is a life,” a Kansas nurse manager said. “It is who you are.”
The nurses who shared their thoughts and stories for this book invite you to peer behind the Staff Only door at the controlled chaos beyond: the jubilance and heartbreak; the temptations, drugs, lies, and violence; the miracles and wonders; the dark humor and innuendo; and most of all, the people who care for us when we are at our most vulnerable and bolster us on what could be the worst or best or last days of our lives.
“Doctors breeze in and out. They do not share the most intimate moments with the patients, but they are the ‘important’ ones who get the media accolades,” a New Jersey nurse practitioner said. “It is the nurse who holds the hand of a patient without a family, who talks to them while they take their last breaths, who aches for them while they die alone. It is the nurse who cleans the patient’s body, wipes away the blood and fluids, and closes his eyes. It is the nurse who says good-bye to the patient for the last time,” she said. “Our story needs to be told. We want to be heard.”
They will be. And you will never view healthcare the same way again.
JULIETTE
PINES MEMORIAL, August
When she left the patient’s room, Juliette retrieved an alcohol swab from her pocket and began to wipe down the pen the man had used to sign his discharge papers. Then she thought better of it. The patient was crazy and probably didn’t bathe often. She threw out the pen, stripped off her gloves, and trashed them, too. Back at the nurses station, she scrubbed her arms, hands, and neck with hand sanitizer, even though she had been wearing a yellow contact isolation gown.
Juliette’s husband made fun of her for being a germaphobe nurse, but she didn’t care. She sanitized her hands so often they were red and chapped. All day long she saw sick patients who didn’t wash their hands, who touched their faces (or worse), and then touched everything in the room. She reminded patients to cover their mouths when they coughed or sneezed, and still, they sprayed the triage booth unapologetically. The first couple of years she had worked as an ER nurse, she was constantly sick with respiratory or GI illnesses. Now she rarely got sick, but she was determined to protect her family from those germs. Even at home, Juliette made her daughter, Michelle, wash her hands constantly. Molly—the opposite of a germaphobe—teased Juliette that she bathed her child in Purell.
The ER felt different without Molly. In the three weeks since Molly had left, the unit had been noticeably quiet and boring. Without Molly’s witty sarcasm and infectious laugh, it was harder to deal with Charlene, the insufferable nursing supervisor. Without Molly, Juliette was lonely at work.