Welcome to Ravenna’s Monday Mumblings!
Last week, we covered the life of a claims adjuster in a US-based insurance company. This week, we tackle what a real nurse does in the USA.
As for my background in this profession, I’ve been a registered nurse for 30 years. For 18 years, I worked in some of the busiest trauma hospitals. I’ve worked in Neonatal ICU (Intensive Care Unit), Surgical ICU, Cardiac ICU, Burn ICU, and Medical ICU. I still maintain my nursing license because I worked really, really hard for it, and would be a fool to give that up.
Again, this post will cover basics only. I don’t expect you to be able to pass the nursing boards after reading it, but if you’re used to getting your info on what a nurse does from TV, you may be in for a few surprises.
Medical dramas almost get it right. Almost. Just like police dramas and courtroom dramas almost get it right. Do yourself a huge favor as an author and ask beyond what you see on TV before you try to write a nurse into one of your main characters.
In the US, there used to be three points of entry into the profession of registered nurse. There are now only two, and the push with most states is to make the BSN – Bachelor of Science in Nursing – the only entry point. What’s important to consider here is that nurses have a college degree. They study anatomy and physiology, microbiology, pharmacology, organic chemistry, algebra, and all the core subjects that are part of most BA or BS programs in colleges and universities around the country.
Their education becomes fine-tuned in what is commonly referred to as “clinicals.” This means going out to local hospitals, nursing homes, or other health care facilities for the day and actually taking care of patients, under the supervision of their nursing instructor. It’s as close to real life as a student will get, although taking care of only one or two patients is still not the same thing. But it does give us hands-on experience, which is where you truly learn how to be a nurse.
In the US, until a nurse passes the Boards, he or she cannot work as an RN. Most hospitals now have transition programs to allow the graduate nurse to get hands-on experience, but he or she still will not have the same responsibilities as an RN who has passed the Boards. Once you pass, you’re tossed into the pit and it’s trial by fire. Not exaggerating here.
Each state has their own Boards, but a nurse can become licensed in another state by paying a fee and/or taking continuing education courses specific to that state’s Nurse Practice Act. They’re all very similar. For example, I currently hold an active nursing license in both Indiana and Ohio. There are education requirements and fees I need to meet every other year with both states to keep my licenses active.
Once you land that first job, and if you’re lucky enough to work in a hospital system with a fabulous mentoring program, you have a chance of not burning out so badly by the end of the first year that you might decide to keep going. And forget those cushy-looking physician office jobs or clinic jobs where it appears all the nurses do is fill out paperwork and stand around flirting with doctors. That’s fantasy. When they are available, they go to experienced nurses, and trust me when I tell you those nurses work just as hard as any of them.
Chances are you’re going to be working in a hospital, and you’re going to have the shit shifts – evenings and nights. We’re talking eight, ten, or twelve hour shifts. We’re talking holidays and weekends. We’re talking working until midnight, or working until dawn. Sick people don’t get sent home Friday afternoon for the weekend, and they aren’t turned away at the door of the Emergency Room simply because it’s Christmas Eve.
You will not make Sunday dinner every week. You will be eating leftover turkey, three days after Thanksgiving. Christmas morning at home with your kids is a fantasy. Or if you are home, you’ve just come off a twelve-hour night shift and you’ll be lucky to stay awake.
You will become used to driving home with the radio blaring and the windows open, even in winter, simply to stay awake long enough to pull into your driveway. You will learn to sleep during the day, even if your neighbors are mowing the lawn ten times in a row.
Expect to go home at the end of a shift with dried blood, poop, pee, vomit, and all sorts of unidentified substances on your shoes and scrubs. Expect at least one dirty needle stick in your career, and dozens of clean ones. Expect to give at least one patient the wrong medication by accident, or at least the wrong dose.
You will watch people die.You will be screamed at by doctors, other nurses, family members, and patients. You will cry in the bathroom during your shift, but only until you get it out because you need to get back on the floor. Expect to learn how to hold in your need to pee for twelve hours, and expect to learn how not to eat more than a handful of peanuts during a shift, just so you don’t pass out in your patient’s bed.
Depending on what area of a hospital you work in, you will care for one or two critically ill (and by that I mean you literally hold their life in your hands) patients, all the way to an entire floor of patients with various medical or surgical conditions. These people are not well enough to be home yet, but are not sick enough to be in an ICU. You may be the only RN on a shift and work with LPNs or nursing assistants, but if you’re the only RN, everything is on your shoulders.
So what exactly do nurses do?
Everything. We take vital signs – blood pressure, pulse, respirations, temperature – for all our patients, anywhere from every few minutes to twice a shift. We give them all their medications. We give them various treatments. We change dressings on wounds. We maintain the patency of their IVs and various other invasive lines. We start new IVs on them.
We watch the numbers on their machines and adjust medications and other treatments, based on those numbers. We give them IV fluids and IV medications. We turn them every couple of hours – lines and all – to make sure their skin doesn’t break down. We clean them up when they poop and pee. We clean up their blood and their vomit when they do that. We sit with them when they’re afraid, psychotic, confused from the medications, or simply need someone to listen to them.
We take them to X-ray, CT scan, MRI, and other places. We chart a lot. A LOT. That’s the documentation piece. Everything. Every. Tiny. Little. Thing. For reasons which I’m sure you can understand, this medical record has to be complete and it has to be detailed. It’s a LEGAL document. It has to be right, and it has to be timely. Because if you’re sitting in court or a deposition one day and have to recall this patient on that particular shift, your charting will be all you have to go on.
We answer phone calls about our patients. We talk to all their doctors. We talk to their family members. When things go south, we must be ready to respond with the appropriate treatment or drug, because we could quite literally save that person’s life. We need to know who to call and when. We need to be ready to give that person accurate and complete information over the phone, even during an emergency, so they can do what they need to do to save the patient’s life. All those doctors you see milling around on TV? Not reality. The NURSE is the one at the patent’s bedside 24/7.
You will go home exhausted at the end of each shift. You will never get out on time. People like to code as you’re ready to give report to the next shift. Expect it to happen. Your legs and feet will hurt. You will buy new shoes every few months. Expensive ones, so you don’t end up with plantar fasciitis, which you might end up with anyway. I had it chronically for about a decade.
Oh… and the pay? I made more as a claims adjuster. Kick that around for a while.
So by now you’re sitting there going why the hell would anyone go into such a profession? Let me tell you why…
Nakisha. A baby with big brown eyes born at 27 weeks (40 weeks is full term) to a mom who had just lost her husband in the crossfire of a drug deal gone bad. She lived 18 months. I dressed her in doll clothes I found, and other nurses in that NICU would come every day I worked to see what new outfit Nakisha was sporting that night. I was one of two people she’d take a bottle from. The other was her mom. Her funeral is the only baby funeral I attended. On the day she died, I found out I was pregnant with my daughter. Yeah.
The World War II vet who was in the Battle of Monte Cassino. I came into his room while he was watching a documentary on that battle to find him in tears. I sat in his room for over an hour and listened to him tell me the details of that battle, including how he held his dying buddy’s hand, in vivid detail. No History Channel show can replace an experience like that.
The woman who looked exactly like Katherine Hepburn. I took care of her on her last day on Earth. When I walked into her room, I said “Oh my goodness, Kate Hepburn is alive!” She laughed and said everyone has always told her how much she resembles the actress. This woman had led a fascinating life, and I loved listening to her stories that shift. She also told me she was going to die that night. She did.
I have countless stories like this. It’s both the most rewarding and the most frustrating profession I have ever worked. But you know what? I’d return to it in a heartbeat right now if I could.
Next week, we tackle what it’s like to be a server in a chain restaurant, and working in a fast food joint.
Until next week, Happy Writing!