I love ER nursing. I really do. I love the rush I get from successfully managing really sick patients. I love the ridiculous things overheard from patients. I love being able to help someone not by giving all the meds or hanging blood or placing an IV, but by holding their hand because it's 6am and they're sad to be missing Easter dinner later today. I love the camaraderie of all the staff placing guesses on the BAL of the local college student who just came in. I love when the ER doctor I've only just met a month ago asks if I'd be willing to housesit for her, because she thinks I'm a competent and responsible person and "would trust me with the house, since I definitely trust you with patients."
There is a lot to love in the ER.
But when someone asked me the other day how I was enjoying travel nursing, I found myself not talking about all the things listed above, but how much I hated the politics of medicine and how awful satisfaction-based care reimbursement is and how resentful I am of the people who come in and get everything they want because they're entitled and know how to work the system.
I found myself saying, "I love the ER, but I kinda hate people now." And that makes me sad. I started this career as a nice person, one who loves people and helping them and was full of naivete and compassion. In return, the direction medicine has taken is slowly overtaking the compassion in me. It's still there, but it's buried beneath cynicism and bitterness.
When I get a patient who says to me, "I hurt and the only thing which works for me is dilaudid," instead of thinking she probably hurts really bad and has been through this before I immediately jump to how much of a drug seeker she must be and how it's bullshit to even be in the ER right now. When a 22 year old comes in on the ambulance for a mild asthma exacerbation, texting and wearing a brand new hat, then asks for a cab voucher home, I don't think that perhaps he is homeless and wearing the only things of value he has in the world; instead I think that he's just a typical arrogant entitled drain on society who will get that voucher because the hospital can't say no without getting a bad review. When a patient lashes out at me and calls me horrible names, instead of thinking that he is in the most stressful time of his life and have reached the crisis point where he can't cope with the stress anymore, I immediately write him off as a horrible person and provide appropriate nursing care but extend only the bare minimum of servility to him. The things about these patients may be true, but the fact that I immediately jump to them instead of giving the patients the benefit of the doubt, if only for a moment, says a lot about me.
I never wanted to be that cynical nurse from the nursing school horror stories. But here I am, waving that flag like it's going out of style. I'm sad to have found myself in this position, because I truly do love nursing and the ER. I'm hoping the system will someway somehow start to be fixed, because seriously. This can't continue.