Frustration Abounds

A conversation I had with the mother of a very sick and very tiny TINY (I guess that should be tiny) baby: (It's worth noting that this is a step above the "Did you have to go to school to do what you do?" question)

Mom: So, how much school did you have to do for this? (As I'm starting a fluid infusion in her infant's tiny IV)
Me: Four years.
Mom: Oh, that's not bad then.
Me: (smile) Uh ...I wouldn't trade it for anything. (She has no idea the HELL that is nursing school. The feeling of constantly drowning. Constant.)
Mom: So did you have to do, like, science and a bunch of stuff?
Me: ...What do you mean...
Mom: You know, like anatomy and biology and stuff, or was it all just nursing stuff?
Me: Well, yeah, there was a good two years of anatomy, microbiology, biology, chemistry, physiology, pathphysiology, all sorts of science just to get into the program. Then there were the nursing classes on top of it. Pharmacology, etc.
Mom: Oh, ok. But then you don't have to remember that anymore because you never use it, right?
Me: (trying SO hard, she's not being degrading, she's quite nice, but WHAT?!) Actually, no, I use every bit of that science every single day in my job.
Mom: (incredulous) Really?!  Wow!

Sigh. It's not her fault. It's not really her that's ignorant, it's society.  Even nurses. I digress. One of the nurses who works in out chest pain-observation unit posted a Christmas card on the announcement board at work wishing all of her coworkers a Merry Christmas. I don't remember the exact saying on the inside. I tried hard to forget, because it is the very thing that irritates me, and it was coming from one of my own!  The gist of the saying was that God had taken two of various body parts (eyes, hands, hearts -probably just one of those) that had various attributes such as caring, soft, sympathy, etc, put them together and called it nurse.  Sigh. A nurse is those things. One-hundred percent. But there was not a single mention of intelligence, skill, knowledge, or things of the sort.

Have you ever tried to search for a quote to highlight these attributes of nursing? I just did. And I couldn't find a single one. Not a serious one. There are all sorts of nursing humor jokes about being nice to your nurse since we keep doctors from killing you. These are funny because they are true. In addition to being kind and caring and compassionate, nurses are intelligent, hard-working, knowledgeable life-saving individuals.

A beloved former coworker of mine, Dr. Graham Walker, put it so much better than I ever could in an article he published in the Emergency Medicine News. Read it --this is why he's a FANTASTIC physician.

I remember thinking to myself and saying aloud to my mother and a few friends that I didn't mean to sound offensive, but I had no IDEA that nurses knew SO much! This was when I was in nursing school. I didn't tell the mother of the infant I was caring for that in fact, the Guinness Book of World Records has named the bachelor's degree in Nursing the most difficult and intellectually challenging of any four-year degree in the world.  And it should be. Think about it. Do you realize that the person who is putting the very small IV in the very small vein of your very small infant is the one caring for your child? Would it not terrify you to think that the person responsible for keeping your child alive did not have an extensive grueling education? That they didn't have extensive training and years of experience? Do you not want -even expect them to be intelligent experts?  I certainly would!

But unless people have gone through nursing school, or been in a situation where a nurse has saved their life or the life of a loved one, how would they know?  The media certainly doesn't paint a picture of this nurse. And I don't think it's their fault, I'm just saying it's not out there.

The terrifying part to me as a health care professional with three college degrees and nine years of emergency experience, is that even as I write this the names and faces of nurses I work with or have worked with in the past are floating through my head. And the faces floating through my head I would not allow to touch a single hair on my nephew's head. I would not trust them to count a single respiration.  Here-in lies part of the problem as well.

Another conversation I had with a coworker last night -regarding another very sick child. I had been asked to get the pediatric resus tray and bring it to a room. If that doesn't get your attention, I don't know what will. I ran to the room with the requested tray and saw a room full of people caring for a very still two-year old child. Still two year-olds are bad. But the nurses and the physicians in the room were fantastic at what we do, and having served my purpose, I left them to do what they do, and returned to caring for my own patients. This conversation was several hours later in the break-room with the nurse who handed off care of the patient just before the resus trays were requested to be on standby outside the room.

Me:  How did that kiddo end up doing? Did he get out of here ok? (he was transferred to a pediatric intensive care unit)
Other RN:  Yeah, he did. He just didn't look that sick at first.
Me: What was his deal?
Other RN: They think it was a bronchiolitis that turned into a bad pneumonia.
Me: Oh. What was his respiratory rate when he first came in?
Other RN: Oh, I don't know. 34 or something unremarkable.

Sigh.  Thirty-four is a normal respiratory rate for a two year old. When I walked into the room with the tray, the child was having oxygen blown near their face, and if he had bronchiolitis and pneumonia and a fever there is no way you can convince me that his respiratory rate was actually 34. It's impossible. I guarantee you it was probably around the 50-60 range. Not good. Here's the problem. Most of us count respiratory rates on the regular adult patient by a 2-second glance and say, oh, it's probably 16. The exceptions to this are ANYONE with a respiratory complaint at all, or a respiratory history, and ANY child. ANY child. EVERY child needs to have their respirations counted for a full minute regardless of what their complaint is. Few people do it. It's wrong. How do we fix it? I've had many conversations with our clinical educator about this (don't get me started on this woman) to no avail. I tell each and every tech I work with that I expect this to be done, and I will make them redo it if I don't think it was done accurately. I also tell them why. I'm the same way with temperatures and appropriately-sized blood pressure cuffs, but that's another post.

I've gotten so very far off track, and honestly most of this blabbering is just for me. I need to get it out, and I get that it doesn't make sense to everyone. I'm just so frustrated!!!  I'm frustrated that I am not respected for the professional that I am in part because of other incompetent nurses. I'm frustrated that I work for a place that keeps hiring people and insufficiently training them. I began my nursing career in a hospital where excellence was expected and anything less was not tolerated. You were expected to come to work and do your job properly and seek out the new and cutting edge technology and information that was at your fingertips. Not every hospital is like this. I learned this while I was travelling. Most of them have been though. And I think we all have a responsibility to make our environment better. I see great opportunity to help here and I just keep running into brick walls. And it's not that I'm the end-all expert in what I do, but I do take great pride in it, and I am good. I could be better, and I strive to become better every hour that I'm at work.  At what point do I throw in the towel and realize that it's not going to work and to put myself back in a situation where excellence is expected, where excellence is the norm? If we can't even fix the deficiencies in our own departments, we can't expect the public to respect the knowledge and skill and experience that we have, because there will always be exceptions. I'm used to working with people like Dr. Walker in the article I linked above. That is the excellence I expect of myself and of each coworker around me. I don't think it's too much to ask when your career is saving people's lives. I don't know what the answer is. I think it should start with the people that are hired, with the people that train them, and for the love of all that is good and holy, sometimes you just need to do people a favor and tell them when it's not working out. Because the ER is not for everyone. And that's the great thing about nursing. There is a perfect spot for every nurse where each one can excel. We're not doing ANYONE any favors by keeping sub-standard employees around of any kind. Sigh.

Remember when I resolved to look for the good in humanity and positive things in my job that could be so easy to loose sight of? Tomorrow is another day I suppose. Sigh.