“Try to tell them about it, they’ll stare at you with those big round candy eyes. They won’t understand zip. It’s like trying to tell somebody what chocolate tastes like.” -Tim O’Brien, The Things They Carried
When I was in 5th or 6th grade, I had a class project researching one aspect of one of my grandparents’ lives. I elected to interview my maternal grandfather, Frederick Fischer. (He died at the age of 88 in 2010, just after my meningitis episode.) I wanted to ask him details about his service in the 101st Airborne in WWII, and specifically about the Battle of the Bulge. He willingly gave me dates and locations during his service. Of note, he was stationed near Pismo Beach, CA for a while, guarding against a possible Japanese invasion. Pismo Beach, for those who don’t know, is one of the locales where my wife lived prior to us meeting at Knox College.
My grandpa was not forthcoming with any specifics of any of the battles, save for dates he was in certain areas. Actually, I didn’t get any specifics on his in-battle experiences. He gave me the following quote:
“If you’ve never been hungry, if you’ve never been tired, if you’ve never been scared, then you won’t understand.”
I didn’t press him on specifics after that. I respected his outlook about the issue. He did tell me that on one occasion, he had to sleep outside (no tent) and woke up covered in a few inches of snow. But his quote didn’t ring a bell until I read The Things They Carried. And I really started to understand better this sentiment during residency and my decade plus as a general pediatrician, working very closely with some excellent nurses. To a person, I think every nurse feels this in their bones as well, at least to some degree.
I have a ton of respect and admiration for all the nurses that I have had the pleasure to work with. I think in the hospital setting, they perhaps have the most difficult job of all. They are emotionally connected to the outcomes of their patients. If a family or patient is upset, they get the brunt of it, and usually shield the doctors from a great deal of the nastiness. If the doctor gets upset, the nurses will frequently get unloaded upon by some of the physicians as well. On bad days, it must seem like a no-win scenario. (It reminds of the Murphy’s Law in physical chemistry – you can’t win, you can only hope to break even, and you get can’t get out of the game.)
I think that being in this middle position, nurses frequently get a lack of respect to just how essential their role is. Sure, as a physician, I made a ton of decisions. But the nurses make as many, if not more, life and death decisions in the course of a shift as the physicians. Many decisions are made in collaboration. (At least that’s how the docs who do it well conduct themselves.) And even if you, the doctor, have the “final call”, knowing you are getting excellent information from the nursing staff is essential for a good outcome.
In the hospital, a nurse is with their patients the entire shift. They see their patients change over the course of hours; they know about family dynamics. As a doctor, I could not be everywhere at once, so sometimes my interactions with families would be limited. Nurses really are on the front line, of just about everything. They provide insight regarding patients and families that would be difficult to obtain otherwise.
I should also bring up a point of which many people may not be aware. Nurses are frequently involved in training physicians. In residency, I rotated around to many different parts of the hospital; in many instances, nursing staff educated me on protocols, how to put in good orders, and just plain old fashioned survival. I might only be in part of the hospital for 3-4 months over the course of my training; the nurses were ALWAYS there; best to utilize their knowledge. Even as an attending, I relied heavily on our nursing staff to lean about what we could do to help patients, and how to do it more efficiently. I was constantly learning from the nursing staff and leaning on their expertise.
One resuscitation involving a particularly sick infant sticks out in my mind, even to this day. We were working very diligently to stabilize a baby. As we proceeded, I was intervening, giving orders, and the nurses were executing in the plan. This is all happened very rapidly. One of the nurses, Sheila, recognized that the infant needed a certain medication. She tried to tell me, and she was only 12 inches from my right ear, but she might as well have been in Siberia, because I just didn’t hear her. Her question just did not register in my neurons. After about 10 or 15 seconds of her asking, she grabbed my face with both of her hands (as though I was one of her children), turned it to her face, and asked, “Do you want me to give the ‘X’?” My response was, “Oh, yes, Sheila, that would be excellent!” She pushed my face back to where it was (she was done with me for the moment), so my attention was back on the infant. The infant went on to be successfully resuscitated, stabilized, sent to the NICU, and had a good outcome.
I came in the next morning (Sheila worked nights), and she was sitting at a desk, looking terrified. I asked her what was wrong. She asked if I was going to have her “written up” and get her in trouble because, in her words, “I put my hands on you!” I laughed, and said no, I wouldn’t be writing her up. When she asked me why, I told her she did precisely what she needed to do to be heard in an emergent situation. No harm was meant; her question was germane, and she desperately needed an appropriate response from me. If anything, I was grateful for her actions. Because of that event, when new nurses would train on resuscitating infants, I would frequently come in on my “free” time to assist with the training. I always told the “face grab” story to the new nurses, because clear, effective communication is essential in any situation (especially in emergencies), and rank of people in the room be damned.
I also remember that a resuscitation instructor was observing our unit in drills, and one of the nurses (Ketra) corrected me on a medication dose during the drill. The instructor was fascinated that she spoke up so freely, and that I was willing to take correction. Our response as a group was something to the effect of “yeah, she was right, and it just needed to be done.” To us, it was no big deal.
Another time, I was involved in caring for an infant that was starting to get sick. I ordered some blood work, which came back normal. When one of the nurses (Jennifer) called me with the results, I told her that with the normal values, we didn’t need a blood culture. She was silent for a minute, and then gave me a disappointed, “Oh, OK.” When I pressed her, she stated that she just was not happy with how the baby looked. Jennifer doesn’t scare easily, so her worry was out of her normal character. Due to her concern, I ordered the blood culture. Her radar was up, and because of that, so was mine. In a little bit, I circled back to double check the infant, based off her response to me. Over the course of a few hours, the child became sicker (although not due to infection). Because of her communication, I kept a closer eye on the child, we stabilized the infant as a team, and that child went to the NICU. I’m happy to say the child is well now. Although the specific test did not save the child, Jennifer’s close attention to the situation did. Her urgency altered how I looked at the situation; no doubt in my mind about it.
I could go on telling stories for pages. The point is that I respected the intelligence and actions of the nurses I worked with. We were a better team, with better outcomes, because of it. I tried to pitch in helping the nurses when things got really crazy. Sometimes they called me “Nurse Dr. Kesselring”, or would ask me if I was using my honorary RN degree for the night (and frequently, I liked my honorary degree better than my “true” title). I took it as a huge compliment. The best compliment was when the pediatricians needed new scrubs. The nurses ordered the pediatrician scrubs in the same color as the nurse scrubs. We were, in their minds, one of them. That might be the highest compliment I’ve received.
I have a friend who is a nurse at a local hospital (name of friend and hospital to remain anonymous at their request); I told them about this piece that I wanted to write. Although I have not worked directly with this person, they willingly gave me a ton of information, and it echoed the sentiments of the piece. “I think nurses are under appreciated because they (people) have no idea the responsibility placed on us… When patients and families see us on the computer, they think we’re not working. But if they saw the large amount of charting and information we look through, they may get it. There’s so much behind the scenes stuff that goes on. I rarely talk about my day with my family because they have no clue.”
That gets to a big part of the issue. Medicine and nursing are somewhat unique; some of your stories do not have an “office world” equivalent. Making major life and death decisions is “just another day”. And until you have lived it, immersed yourself in it, and breathed it, it’s hard to comprehend. It goes back to the opening quote. How do you explain what something is like to someone that has never had a similar experience? Tim O’Brien goes on just after the quote (about explaining the taste of chocolate) to ask how you explain what $*** tastes like. The definition cannot be expressed; it has has to be demonstrative, or at least a shared experience.
Aside from me tugging at people’s heart strings, there is another good reason why I’m taking up the cause for nurses. Lots of people deserve a well earned “thank you” and more collective respect. If making the argument for appreciation for your nurses cannot be won on an emotional level, it can also be won with data.
I think to individual patient survival, as well as a collective “health to the masses” issue, nurses are probably more important to good patient outcomes and patient survival than your doctor (at least in a hospital setting). If you beat your nurses up, under staff their units, burn them out, and generally don’t take care of them, it eventually shows up in poorer patient outcomes. You are liable to see more mistakes made in patient care, more errors (whether fatal or non-fatal), and ultimately, death. Happy, empowered nurses, that have an increased say in decision making and that are appropriately staffed perform better at their jobs. Period. And if you don’t believe me, maybe pay attention to these links:
I think that five links are enough. I will stress that this is not an exhaustive review of the literature, but you should get the picture. Even if you are a completely cold-blooded, heartless, selfish, sorry-excuse-for-a-human being (and you don’t care about treating nurses better), you damn well better care about your own survival if you are admitted to the hospital. On a completely basic level, we should all want empowered, happy nurses. Why? YOUR life depends on it.
I want to emphasize that overworked, stressed out people in any occupation don’t try to perform worse at their jobs. Psychologically, it just HAPPENS, and I don’t see how you can guard against it. Unless policies are enacted in a meaningful way, there is a collective cost to the public, to society, when we don’t treat people well. I don’t care if it’s because you are a bleeding heart or have “capitalistic compassion”, the effect of treating people poorly has a cost. And when it comes to nurses, the cost is not just fiscal, if you catch my drift.
So, THANK YOU, to the nurses that have trained me, worked with me, taken care of me when I was a patient, taken care of anyone that I have cared about, or (even if I don’t know you) are involved in the endeavor of taking care of patients. In my view, you are the most essential part of the system. Keep up the good work. You deserve more than a “shout out” for trying to heal us, make us healthy, and getting us home to our loved ones. But, as Bono sings during “Until the End of the World” during the Innocence and Experience tour, “These are just words, and words are all I have.”