The Making of a Nurse (35 page)

What a great idea, I thought, because even if I hadn’t read all the studies – which I had – I knew that nurses saved lives. Actually, I’d realized that truth instantly, years ago, when Justine walked in wearing a T-shirt that said, “Nurses – there to save your ass, not kiss it.”

MEANWHILE, IN THE ICU
, major changes were underway. Dr. Sandor took us all by surprise one morning with the announcement that he wanted the nurses to take charge of morning rounds. The nurses would present their patients’ medical history and results of diagnostic tests. He wanted the nurses to draw conclusions and not merely rhyme off the numbers, but rather, “To do something with those numbers and put the whole picture together.” Dr. Sandor had always been disappointed in nurses who didn’t make a significant contribution on rounds or who didn’t take initiative with their patient care. But, he had always consistently believed in us even when we didn’t believe in ourselves. Time and time again he threw down the gauntlet of taking on bigger challenges in our practice. He’d always been our strongest supporter, yet not everyone realized it. I’d watched him take aside a group of residents on their first day in the
ICU
and tell them, “Listen to the nurses. They know everything about the patient and you’ll learn the most from them.”

“It’s time the nurses took on more of a leadership role,” he told us in a meeting.

“More work?” some complained bitterly.

“We’re not doctors,” others objected. “Is he expecting us to be doctors as well as nurses?”

Over the years, nurses had been taking on more and more of the tasks doctors used to perform and most saw this as an advancement
and enjoyed those added responsibilities, but clearly not all saw it that way.

I remembered a night I was working and a young woman arrested. We tried for two hours to resuscitate her. The husband and her family were in the waiting room, hoping for good news. At midnight, we called off the code – I remember because the time of death was exactly 0000 hours. The doctor looked at me. “I have to go out there and tell them, don’t I?” He was inexperienced and scared. He had never broken such terrible news. Also, he didn’t have a relationship with the patient or her family. On the other hand, I did. She was a high school teacher and I had often brought her two young children in from the waiting room to visit her. I had spoken many times with her husband, a dentist. “How about we go together?” I suggested. “I’ll tell them, but it will mean a lot if you’re there, too.” He said he couldn’t go. He had to write orders and there was a dialysis line to put in. What did I need him for, he asked? Couldn’t I do it on my own? I recalled a conversation I’d had with him a few days ago when I’d asked him out of interest, as I always do, what he was planning to specialize in. “Nuclear cardiology,” he’d said. He was adept at procedures and probably got top marks in biochemistry and physics. He would make a good scientist. (Tracy and I stifled our giggles the time he’d asked during rounds, “When’s lunch?” and the staff doctor shot him a withering glance.)

As I walked out to the waiting room, I moved extra-slowly, trying to draw out the time when the family could still believe they had a wife and a mother. No, not everyone had the tact or maturity to deliver bad news, but I knew that I did, and that night, I did it the best I could.

I wanted Dr. Sandor to clarify his new plan for rounds. “What, exactly, are you asking the nurses to do? Some of them are unsure about their new responsibilities.”

He looked at me in exasperation. “It’s not rocket science. I want the nurses to take the lead. They will present the medical history, review the systems – cardiac, respiratory, and so forth – and highlight the problems. I want the nurses to interpret the data, spot
trends, suggest approaches. They can do more than merely rattle off the numbers from the flow sheet.”

Even Tracy had reservations. “What if I miss something important?” she asked, though she was one of the nurses least likely to miss anything.

“They don’t pay me enough to take on even more responsibilities,” one of the others said.

“I can’t understand why this is so radical,” Dr. Sandor said. For years, he’d been trying to get us to take ownership of our practice. Whenever it was decided that a patient was not to be resuscitated – a
DNR
status – and we asked Dr. Sandor to write that in the chart, he would refuse. “If the nurse knows the patient’s wishes, a doctor’s order is not required. The nurse knows the right thing to do.”

“But we need it in writing,” we insisted.

“Nonsense,” he said, and showed us a copy of the policy from our own College of Nurses that clearly stated that nurses could act independently in these situations in accordance with what they knew were the patient’s wishes. He was getting impatient with us and was baffled that some nurses were reluctant to jump at the opportunity he felt he was offering. Here he was endorsing our profession, much to our protest.

THE ICU
outreach team was now in place. Nurses were roving all around the hospital, responding to problems and dealing with them on the spot. They told me what they were seeing.

“On the floors, it’s mostly junior nurses. There’s no one they can ask questions or look up to,” George said. “One nurse told me she’d never changed a chest tube drain and she had four full ones, so I did it with her. I was with a nurse when a patient arrested and it was her first code so I showed her how to push the
IV
drugs.”

“I think they feel that now they have someone to call, someone nonjudgmental who won’t give them a hard time,” Tracy told me.

“It infuriates me how doctors don’t listen to nurses! We all know that can be lethal,” Roberta told me, “but I see it, time and time again, especially on the floor.”

“Yeah,” I agreed, “but what’s worse is when nurses don’t speak up in the first place.”

The outreach team had only been in place for a few months when a patient came in to visit. I didn’t recognize him at first and asked if I could help him. When he told me he was Mr. Spruce who had undergone a lung transplant a few months ago, I gasped. Here was this man looking so healthy and vibrant. I had only known him intubated and unconscious. He wanted to thank us all, but particularly Tracy, who wasn’t on that day. “Do you want to leave her a message?” I handed him a paper and a pen.

“It’s a hard thing to put in a note,” he said with a wry smile. “How do you thank someone for saving your life?” As he started to tell his story, people gathered around him in the hallway.

“I could feel myself going down. I now believe I was close to death. I barely had the strength for the next breath. Nurses were all hovering around me, but didn’t know what to do. They were waiting for the doctor. Someone went to find one and then I was left alone. I could feel myself losing consciousness. When Tracy arrived, I immediately remembered her from the icu. She didn’t say much, but she knew exactly what she was doing. I could feel her rescuing me. She put in an iv and poured in fluid. I felt myself coming alive again. I don’t know what else she did, but I know she saved my life. Please tell her when you see her.”

Yeah, I’ll tell her. Hey Tracy, you’re not just a pretty face and a kind heart. You saved someone’s life
.

The outreach team, a “flying squad of experts,” as one hospital official called it, was working out well. The staff doctors said the
ICU
nurses were like another pair of eyes and ears on the floor. One said it was like having a medical resident on the floor, taking care of everything. The floor nurses appreciated the support the
ICU
nurses were offering. Patients and families were already feeling and noticing the improvements. However, there was one recurring and troubling note of discontent among the nurses.

“Why should I take on more responsibilities without more pay or recognition?” one nurse asked me.

“Aren’t there other satisfactions to be had than money?” I shot back.

“Look, Tilda. Money’s an issue. Deal with it. I’m getting thirty-three dollars per hour and I am not going to do more than I’m already doing in the icu. I’m not going to read X-rays or write orders. I’m not going to examine the patient and explain to the first-year resident what needs to be done. If they want more from me, they’ll have to pay me.”

“What about professional development and job satisfaction, don’t they count for anything?” I asked, but my question met with a torrent of protest from others who gathered around us.

“If they think my knowledge and skills are valuable, then they should pay me for it,” one nurse said. “The doctors are getting paid more, why not us?”

“It’s like during
SARS
. For three days I looked after a
SARS
patient and not one doctor came in the room to examine him. I told him how the patient was, I wrote the orders, and the doctor co-signed them.”

“Don’t nurses have enough work to do without taking on some of the doctor’s role, too?”

“But other professions will take it on if we don’t and you know what we’ll be left with, don’t you?” someone countered. “We’ll lose even more nursing jobs. Other professions will take over.”

“Is our hold on this profession so shaky that the only way to prove ourselves is to be like doctors?”

“If the public really knew what nurses did, they’d want our salaries to be commensurate with the stakes and the responsibilities we take on.”

After listening to their concerns, I realized that finally, we had arrived at the frontier of the last taboo: it wasn’t sex or death or poo – it was money. If we were
virtual
nurses – nurses virtually acting like doctors, yet not being formally recognized as such, nurses virtually being doctors’ eyes and ears, rushing off here and there –
and
if we also were expected to be so
virtuous –
noble, angelic, altruistic, and sweet – how could we care about something as crass as money?

But here’s my two cents for what it’s worth: I believe we have come far enough that we can have it all.

I
have never felt I needed a break from the icu, but when an opportunity came up to try something completely different, I was surprised at how fast I grabbed it. The job advertised at the back of a nursing journal sounded fun and easy, with lots of benefits:
Wanted: Registered nurse with fun-loving personality who wins trust, to work with children ages eight to sixteen at a summer sleepover camp in the beautiful Haliburton Highlands
. In exchange for providing basic first aid as needed to 350 campers and staff for four weeks, my own kids would get to go to camp for free. There would be a doctor from the local town on call and should a serious problem arise, there was a hospital forty-five minutes away.

“I love camp,” said Terry White, the director of Camp Gitchee-Goomee at my job interview. His face could barely contain his broad smile and twinkling eyes. All of twenty-eight years old, he seemed like the quintessential “happy camper” himself. “I wish I could have gone to a camp like this when I was a kid, but my folks couldn’t afford it. You’ll never find me in my office. I’ll always be out on the lake with the kids or on the basketball court.”
His grin lessened briefly to level with me. “The truth is, the nurse’s role is hard work and long hours, but it has its rewards, as you’ll discover. Your own kids will have a blast.”

All in all, it sounded like a great arrangement and though I knew Ivan would miss us, the bonus he would enjoy of being able to get in a few extra late-night poker games and afternoon rounds of golf while we were gone would more than compensate for our absence. As for meals and the house, he was a much better cook and housekeeper than me, so I didn’t worry about that.

“Our campers are healthy kids from well-to-do homes who sometimes get a little freaked out when forced to be unplugged from their electronic worlds and to deal with nature. It’s quite a shock to their systems,” Terry continued. “Another thing I should mention is that we have a few campers with special needs. One boy is in a wheelchair and comes to camp with an attendant. There’s a diabetic teenager who’s on an insulin pump, and a child with mild autism.”

“No problem. I’m sure I can handle anything that arises.” I sounded and felt confident. “I know what an emergency is and what it isn’t, and as for kids with special needs, as a parent, I know every child’s needs are special, at least to that child and parent.”

My answer seemed to please him. “Spoken like a true nurse and mother, too. In fact, your skills as a mother will come in as handy as your skills as a nurse. The camp nurse is a mother figure,
in loco parentis
. Sometimes all the kids need is a hug or a shoulder to cry on.”

I understood that. It’s exactly what I needed most of the time, myself.

“Homesickness,” the director said, walking me to the door at the end of the interview, “is usually the main complaint. It seems to underlie almost everything the kids come to the infirmary for.”

I knew a thing or two about homesickness. I’d had a bad case of it myself, all my life, especially when I had been at home. Problem was, I still didn’t know how to treat it.

My kids were excited about going to camp. Max was a good swimmer but had never swum in a lake and he fretted about that. Harry bought a net on a long rod and was eager to start catching bugs and butterflies, or better yet, frogs. It would be a great
adventure for them and I was pleased to be able to offer them this rich experience that I had missed out on. My parents never allowed me to venture out into nature. They considered the outdoors an uncultured, irrelevant place – not to mention dangerous and dirty, too. My summers were spent with safe books in clean hospitals and libraries. But I wasn’t going to allow my own kids to be as deficient in this area as I was. They would learn to water-ski, sail, steer a canoe, pitch a tent, build a fire, and hike through the forest. Most of all, I hoped, they would learn to love nature.

A few days before camp started, I went to the camp office in the city to review the health forms that the parents had sent in ahead of time. There were no surprises in the medical section: lots of hay fever, some food allergies, a few kids with well-controlled asthma, and a girl who had to wear a patch for a lazy eye. They were healthy, but in the section where the parents were asked to list their concerns, there was quite a number and variety of responses: