Dear Lit Loves,
As regular readers of my blog probably know I write about the personal experiences I have encountered with our medical system in this country via my own peculiar illnesses including Uveitis, Uveitic glaucoma, Meniere's disease, and some unknown or undiagnosed autoimmune disorder that is believed to have given rise to all these illnesses (no one's been able to pin down an exact autoimmune problem). Additionally, I've seen my dad cope with Anaplastic Large Cell Lymphoma, a stem cell transplant, quintuple heart bypass surgery, and most recently, a new targeted drug therapy which eliminated the cancer yet subsequently, my dad died this year of pneumonia and heart failure. My mom has had breast cancer and I've dealt with basal cell carcinoma which was a walk in the park compared with potentially losing my eyesight and hearing. Thus, I may not be the best person to evaluate the book entitled The Nurses: A Year Of Secrets, Drama, And Miracles With The Heroes Of The Hospital because I admit I am a bit biased as I think the real heroes of the hospital are the patients themselves. Since I've been reading books that address the medical chaos my family and I have experienced, I'm always ready to read what someone else thinks of the medical establishment and what types of experiences they have encountered with hospitals, doctors, interns, residents, hospital administrations, etc.
First let me say that in my opinion the book The Nurses: A Year Of Secrets, Drama, And Miracles With The Heroes Of The Hospital is not necessarily exclusively memoir or exclusively narrative nonfiction; I think it is actually a combination of both. It was written by an experienced journalist. Ms. Robbins follows the stories of four different nurses who are at different levels in their nursing careers. She also gives quite a bit of detailed information on the burnout rate of nurses, inadequate working conditions nurses encounter, the gallows humor doctors and nurses utilize to "blow off steam", the clique-like nature among many nurses, and the notion that many nurses suffer a form of post-traumatic stress disorder as a result of the injuries they witness and treat or hostile patients and a patient's family members. So let's start first by taking a look at the four nurses the author shadowed.
Nurse #1: I am referring to the nurses as numbers because I don't want to spoil the book for anyone who has yet to read it. Nurse #1 is in my opinion, the best of the group. She's ethical, will stand up for herself in the face of an arrogant doctor, and can work effectively as a nurse in almost any kind of hospital whether it's a hospital located in the most violent part of a town or one located in the suburbs visited by affluent patients. She recognizes when she is exhibiting symptoms of nurse fatigue or burnout and she has ways of taking care of herself and assuaging the demands of the job so she can always bring her "A" game to work. She appears to be a team player and never displays any tendency to misuse some of the powerful drugs she is required to administer to patients.
Nurse #2: Nurse #2 is the chief breadwinner for her family. She has a rather revolting husband who she acknowledges probably cheats on her, is verbally and emotionally abrasive toward her, and who appears not to really care when she finally leaves him. He stays home and takes care of the kids and depends on Nurse #2 to provide for him and the kids though she moved out and relocated to an apartment. This nurse also had a tendency to suffer migraine headaches which she often did not have time to take off work and go to a neurologist for examination and prescriptive meds. She had a previous drug problem as a teenager I believe and she falls into using leftover vials of pain meds to alleviate her headaches and the pain from them. She finally admits to stealing and utilizing the pain meds and in order to save her nursing license, she goes for drug abuse treatment and spends several years on desk duty or probation before she is allowed to return to being a bedside or ER nurse. The interesting part is that a hospital later recruits her to improve conditions for nurses at the hospital; however, she appears to be the only one to really buy into the concept of improving conditions. The hospital had formed a group of medical personnel to find ways to improve nurse morale, but none of the more important ideas are ever truly implemented by the hospital administration even though they are aware that nursing morale is a its lowest and they have a high turnover rate among nurses.
Nurse #3: Nurse #3 has the tendency to allow a charge nurse to assign her way too many patients than she can properly care for or supervise in a single shift. She realizes that there is a clique of nurses on her unit. They go out together, correspond online, and in Nurse #3's opinion, exclude her from the group. Honestly, it was almost like high school social cliques. I found the whole idea juvenile, but this nurse felt she was being excluded and it led to quite a bit of resentment. And I had no idea how one nurse or group of nurses can actually demonstrate bullying behavior until this nurse's experience. Nurse #3 is well-skilled and devoted. She had a tendency to overshare detail from her personal life with her charge nurse in an effort to make a friend or possibly gain entrance to the nurse clique in her unit. This backfires when she wants to move up the clinical nursing ladder as the charge nurse uses that personal information not to recommend her for a higher position.
Nurse #4: Nurse #4 is the youngest and least experienced among the group of nurses that were shadowed by Ms. Robbins. She initially is shy and to me, makes some questionable choices when it comes to combining your private life and career life. At one point she dates a doctor on her unit who is many years older than her. And it appeared that she had a reputation for getting involved with medical staff at other hospitals where she worked. She does develop her confidence to stand up to senior nurses who like to bully new nurses and I was proud that Nurse #4 did learn to not be afraid to question doctors and do what is necessary to advocate for the patients for whom she is responsible.
The amount of research the journalist author did was astounding. For example, the most frequent bullying medical personnel are general surgeons, cardiovascular surgeons, cardiologists, othopedic surgeons, neurosurgeons, and neurologists. The hospital departments most likely to have bullying employees included the Operating Room, Medical Surgery Unit, Intensive Care Unit, and the Emergency Room. The worst holiday for nurses appears to be New Year's Day and that's because of the number of drunks that go to the hospital. There appears to be an unspoken "Code of Silence"among nurses in that you do not "rat out" another nurse if you see her displaying suspicious or questionable behavior. The worst time of the year to get sick appears to be in July when there is a mass influx of new interns and residents that become directly indoctrinated into hands-on patient care. The hospital morgue is never labeled "Morgue", but something more along the lines of Anatomical Pathology so hospital patients and visitors don't get freaked out by the notion of death or dead people. Even if as a patient you have a DNR (Do Not Resuscitate) paper, it might get ignored if you are unconscious and your family puts up a fight to have you ventilated and treatment continued. I definitely did not agree with the notion of experts recommending healthcare professionals use gallows humor as a survival tactic and as a means of preventing burnout. Now, it's one thing for nurses to prank one another. It's a whole other ballgame when doctors make fun of obese patients on the operating table or hospital personnel keeping something known as a "butt box" for all the different items that have to be removed from patient rectums. Honestly, I thought that was unsanitary and gross. Also, I found it highly immature of hospital personnel placing bets on patient outcomes of risky surgical procedures, a patient's blood-alcohol level, or who can best guess the incoming injuries of a patient arriving by ambulance. Hello! This not high school folks! And who in the world knew that there was such a thing as a "slow code" which basically means hospital personnel are to respond slowly to a patient who is not expected to survive and responding hospital personnel should just generally go through the motions of attempting to revive the patient.
Honestly, we're going to need more nurses in the future with all the baby boomers who are retiring and living longer. According to this book, good work environments for nurses include favorable/low patient-nurse ratios, positive and not demeaning nurse-doctor relations, nurses being involved in hospital decisions, and managerial or charge nurse support for nurses who have no choice but to take on eight patients at one time. I would venture to say it would be important to have fellow nurses who are supportive as well and to work as a team.
What do nurses advise for hospital patients? Have a family member with you at the hospital and have someone who can be the spokesperson that interacts with the nurses and doctors so that person can relay the information to all the other family members. Ask questions of your doctor. Honestly, if a doctor doesn't present a condition or treatment in terms you understand, by God, make him/her repeat it or find someone who can explain it to you so you are well-informed. Patients should be informed by knowing their meds, diagnoses, allergies, and emergency contact numbers. Also, watch the hygiene habits of hospital staff members. If hospital personnel do not wash their hands before touching you, ask them to do so because you're safety and well-being may depend on it. I felt the nurses left out the need for hospital patients to have a living will or how much extraneous care do you wish for yourself if you are incapacitated. Make sure you have a healthcare power of attorney and that the hospital personnel knows who that is. Also, if you wish for your doctors and nurses to provide updates and health information to extra members of your family such as children, you better make sure you've signed a HIPAA waiver form that enables doctors and nurses to exchange that information or those family members could be left in the dark completely.
I learned quite a bit about the nursing profession and the positives and negatives of a career in nursing from this book. As a person who writes strictly memoir, it was often hard to keep up with the personal narratives of four nurses from chapter to chapter because nursing research and statistics often concluded each chapter. I missed the continuity of following the story of each nurse and oftentimes found I had to go back and reread a section just to make sure I was clear on what was occurring for each shadowed nurse throughout the book's entirety. The research information was outstanding and concise. I now know that I will be paying attention to the actions of nurses I encounter at each clinic or hospital visit I make based on what I've read in this book. It makes for a more informed patient and a more informed patient advocate. And most people will tell you I am all for information sharing and being your own best medical advocate.
Till my next read or publishing update,
Grace
(Amy)
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