Wednesday, May 14, 2014


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.


Jono said...

Long ago I needed only nursing classes to get a BSN. Life happened and I never finished. Afew years back I went back to be a Lab Tech figuring I had gotten too old a cynical. Too many things had changed and I saw them for what they are. Went back to working in a lumber yard.

girlvet said...

You still care. Think of the last person who you thought about the next day and wondered how they were doing and hoped they were all right. Its hard as an ER nurse to remember those times when you did care. ER sucks the life of you and we as nurses have such high expectations of ourselves. We are human. We are reacting to an overwhelming, constantly changing environment. You do a great job in a difficult situation.

Aesop said...

You aren't cynical.
You just aren't naïve anymore.
Like virginity, naivete doesn't grow back.

In our job that's a plus; as long as the BS detector is working, likely the other sensors are tuned as well, which means you won't miss something important.

Which is why the docs trust you with patients, or their house.

What can't continue is anyone putting up with bureaucratic happygas and measuring our job performance by such ridiculous flights of whimsy as "patient satisfaction scores", which is BS of the rankest kind.

A Patient Satisfaction Score is a pulse rate in my book. If you had one coming in, and you have one going out, I win. Everything else is counting hairs with an electron microscope.

My stupid and pushy patients get annoying at times. Just at times.

But the drooling asstards who come up with after-care surveys (like M&M reports aren't a bit more precise and germane), and the fawning butt-kissers in administration who treat those unicorn farts like they matter make me want to go postal with machetes.

A nurse who harms a patient should have their license suspended or revoked; one who took to euthanizing the folks from Press-Ganey, JCAHO, or most hospital CEOs should probably receive an honorary Ph.D., national nursing honors, and be appointed to run their state's BRN. In certain circumstances, presidential awards and a trip to Washington shouldn't be ruled out.

That's the crap that makes it hard to put the scrubs on.

The difficult patients are merely entertainment, and the great ones are humbling.

And nothing solves problems at work, or the work itself, like a few days far away from it. Summer's coming, palm trees and beaches await, and those fruity drinks and seafood aren't going to consume themselves.

Unknown said...

I totally understand the burnout. I worked in rural health for 6 years and built a large practice. I recently changed locations and though I miss many of my patients, I find myself sighing in relief that most cannot follow where I went. Never thought I'd feel that way.

GG Scarf said...

You are right: this really is a systemic problem - and a HUGE one!! You guys in ER are the first line in health care and that includes behavioral health and primary care! Anyway, your attitude will actually save you from total burnout. Your sense of humor will get you through -- but until things change in society (civilization as a whole) expect MORE cab vouchers, pregnancy tests and requests for dilaudid. Thanks for being there,

Unknown said...

I totally get you on this having worked the ER and the ICU. But there are times when I question if it is really the system that is "broken" or if it is the people. People these days are WAY more self centered and entittled. Other countries have health care systems that are way more permissive then ours and their consumers don't take advantage of it the way they do here in the US. Perhaps it's a societal problem, but god forbid we say that! We're perfect!

The only other thing I can tell you is there are a lot of bad apples out there and most of the come to the ER. Don't let them ruin the bunch. I have met people in the ER and ICU that are grateful, sweet and caring people. Hold on to the memories of them and remember how much you are helping them. Don't let the bad apples ruin it for those people, the ones that are thankful for your great care of them.

Kaley said...

I'll pray for you boo. It's a lot of dying unto yourself I'm thinking. And strength from Jesus. Sin is dirty and big and but Jesus is big too.