“Yeah, they are such mean girls here,” the nurse said. “No one helps anyone out, and there’s definitely a social hierarchy.”
Molly noticed the hierarchy during her shift the following day. Seven nurses were apparently the “cool” nurses in the ER. They were 22- and 23-year-olds who, as Molly observed, “do their hair and makeup like they’re going clubbing.”
The cool nurses hung out together exclusively, which was fine with Molly, but the techs wanted to help only the cool nurses, which was not fine. Molly happened to be charting at the nurses station next to Lena, the clique leader. Whenever another “cool nurse” walked by, Lena stopped her. “Hey, we’re going to happy hour tonight, but don’t tell anyone, because I only want the cool people there,” Lena would say.
Molly shook her head in disbelief. After six cool nurses—and fifteen apparently uncool nurses—passed by, Lena turned to Molly. “I guess you can come, too”—she paused—“if you want.”
At first Molly was astonished by the nurse’s immaturity. She had to remind herself that these were girls, not women, and that they weren’t that many years out of high school. She was constantly amazed by the ways that some of these young nurses could act like teenagers one moment, then flip a switch and impassively handle high-pressure patient situations the next. ERs could hire new grads to work on codes when they were doing keg stands a month ago. Molly decided not to call the nurse out on her behavior because it didn’t affect her, unlike the charge nurse’s attitude toward agency nurses. “I already have plans,” she said. She would not return to Riverport again.
Molly had heard that some staff nurses treated agency nurses poorly, but she was surprised now that it was happening to her. “If the agency nurses weren’t there, the staff nurses would have a much higher patient ratio,” she explained. “We make their job easier, but they’re rude and unfair.” Another agency nurse had told Molly that one day she had arrived at an ER that had a total of seven patients. The charge nurse assigned her all seven. When the nurse asked why, the charge nurse said, “You’re agency. You’re getting paid more than us. You can handle it.”
Some hospital administrators were partly to blame for creating an us-versus-them mentality. During October’s Emergency Nurses week, one of two nurse appreciation weeks during the year (the other is National Nurses Week in May), hospitals usually gave nurses tokens of appreciation. At an Academy Hospital staff meeting Molly was required to attend, the ER manager had given plush blankets with Academy’s logo to every nurse in the room except Molly. “Sorry, these blankets are for staff,” she said. How easy would it have been to give out one extra blanket instead of making me feel like I don’t contribute to the department? Molly thought.
Molly cared less about the gifts than the sentiment. Academy supervisors had repeatedly told her that she was a valuable nurse and had asked her to pick up extra shifts. “I probably would’ve used it as a dog blanket anyway. But really, right in front of me? ‘You’re agency, so we can’t give you one?’” she groused to a friend. “Why are you going to make people feel excluded when we’re there to help you? All of the agency people are experienced nurses. Why are y’all trying to create animosity between the two?”
Citycenter Medical
By the time Molly finished an exhausting shift at Citycenter, 110 patients waited in the ER, more than many ERs saw in an entire day. That night, Molly vented to Trey about Citycenter. He listened patiently to her, like he always did.
“So stop working there,” he said. As usual, a man of few words.
Molly paused for a moment to reflect. Why wouldn’t she simply stop working at Citycenter? Academy was easier (though less interesting). “I don’t want this job to beat me,” she said. “I don’t want anyone to think I can’t handle it. I don’t think any job is too hard for me, and I don’t want to walk away.”
“If you’re getting burned out, just work a day or two every once in a while,” Trey suggested. “Lowering your stress level might make it easier to get pregnant anyway.”
“That’s true, but I’m not stressed. I’m just angry. And full-time Citycenter nurses are putting themselves through those conditions every single day. If I walk away, I’ll feel like they are stronger nurses than me.”
“You took the agency jobs to see if there are better hospitals than Pines,” Trey said, affectionately squeezing her shoulder. As he left the room, he added, “Maybe there aren’t.”
The next day, Molly had just given report to a night-shift nurse when an ambulance brought in a little old lady who had fallen. She had been assigned to a room, but the Citycenter nurses were swamped with other patients.
As Molly passed by the woman’s bed, she noticed that the woman had urinated on herself. Molly was weary and off the clock, but she knew that if she didn’t help the patient, she would be sitting in wet clothes for hours. Molly worked up a sweat as she struggled to change the woman’s clothes.
The woman was grateful. She said sweetly, “I think anyone who is an ER nurse must really want to be an ER nurse. It’s such a difficult job.”
“I think so, too!” Molly said.
On her way home that night, Molly reflected that the woman was correct. “As much as I complain about all the B.S., if I didn’t want to do it, there are lots of other options in nursing. But I choose the ER. There’s a sense of satisfaction that comes with ‘fixing’ people,” she said. “In so many areas of healthcare, people have long-term treatment for things they may not recover from. In emergency medicine, a person comes in with crushing chest pain, gets diagnosed with a heart attack, gets meds, gets shipped to the cardiac catheterization lab, and gets fixed. A person comes in with abdominal pain, gets diagnosed with appendicitis, goes to the OR, and gets fixed. I need to remember that I chose this specialty. The reality is healthcare is broken. I need to figure out how to either let it go or decide how I can contribute to fixing it.”
Molly had no desire to be a floor nurse. At every hospital where she had worked, there was a rivalry between the ER and the other nursing departments. “We think they’re lazy and they think we’re bitches,” Molly said. One of the most frequent complaints ER nurses had against floor nurses was that floor nurses tried to avoid getting new patients as shift change approached.
Many floor nurses made excuses to Molly and her colleagues for why they couldn’t take a patient at shift change. “The room’s not clean” was one of them. More than once, Molly had gone upstairs to the floor, found the room to be clean, and called the nurse’s bluff. Another favorite was “There isn’t a bed in the room,” which meant housekeeping would have to bring up a bed. When one floor nurse used this excuse, Molly discovered that the nurse herself had pulled the bed into the hallway to avoid getting a new patient when she wanted to leave work.
During Molly’s next Citycenter shift, she called the medical/surgical floor to give report on a patient. The nurse who answered the phone said that the patient’s nurse-to-be was on break.
“Okay, I’ll give report to whoever is covering for her,” Molly said.
“There isn’t anyone covering,” the nurse said.
Right, Molly thought. This hospital is so fucked up. “So if one of her patients needed something while the nurse was at lunch, who would help them?”
“Me,” the nurse answered.
Molly didn’t miss a beat. “Okay, then you’re going to be getting a forty-four-year-old female admitting for intractable vomiting . . .”
LARA SOUTH GENERAL HOSPITAL, November
In the middle of the nurses station, two nurses were screaming at each other. Lynn, a young ER nurse, was trying to move a patient to the psychiatric department, but the patient’s blood sugar was high, at 200 mg/dL, when normal levels ranged from 70 to 100. Tashia, a psychiatric nurse who had been at the hospital for many years, wanted the patient’s blood sugar stabilized before moving the patient upstairs. She told Lynn, “No, we’re not
taking her yet.”
“You’re a nurse. You can treat the blood sugar just like we can. We need her upstairs. She’s being admitted for treatment,” Lynn protested.
“You don’t know what you’re doing!” Tashia yelled. “You’re incompetent! You’re a horrible nurse!”
The nurses station quieted. Tashia, who was nearing retirement, was known to be a bully, but this was different. She was yelling at Lynn in front of other nurses and patients on stretchers in the hallway, including the patient in question. From their rooms encircling the nurses station, ER patients peered through the curtains at the spectacle.
Lynn raised her voice right back. “Don’t you dare call me names!”
Tashia got into Lynn’s face, her finger within poking distance of Lynn’s eyes. “You want to hear name-calling? Fine! Everyone thinks you’re a skank!” Lara hadn’t heard that before. Lynn was a petite, beautiful black woman. Lynn didn’t say anything. She walked away.
When Lara finished her charting, she caught up with Lynn in the hallway. Rose was already there, patting Lynn on the back. Lara asked if she was okay.
“Yeah,” Lynn said. “I felt like if I came back at her, I’d be yelling at an old woman. She’s an angry, bitter woman.”
Still, Lara could see that she was shaken by Tashia’s outburst. This was Lara’s only complaint about South General: A small but unavoidable group of the nurses was verbally abusive. While at other hospitals, the bullying could be more covert or passive-aggressive, at South General, hostilities were blatant. “There’s some serious attitude here. Maybe it’s from years of having grown up in this rough area,” Lara observed. “People put up an angry, defensive wall. It’s difficult to break down that attitude with each individual coworker.”
Despite racial tensions, Lara, one of the few white nurses at the hospital, hadn’t landed in anyone’s crosshairs. Evidently someone had noticed that Lara seemed to get along with everyone, because in November, the ER director selected her as one of fifteen people to join a new hospital-wide committee. A healthcare management company had developed the Relationship-Based Care program with the goal of improving staff members’ attitudes toward each other so that they could work better as a team. South General had just signed up.
The committee’s mission was compassionate and holistic. The mandatory three-day RBC conference emphasized the message, “If you take care of yourself, you’ll be a better person, better mom, better wife, better coworker, better nurse. When your coworkers are looking out for each other, it will become a more therapeutic environment,” Lara said, excited to help. The instructors asked the groups to brainstorm what they could do to improve relationships in their hospitals.
Lara’s committee, consisting of six ER staff members and six nurses from other floors, decided that their first short-term goal would be to set up crisis intervention help for staff. Hospital professionals grappled with traumas and tragedies in different ways. Lara suspected that another South General nurse was turning to narcotics to cope. Fatima was a 28-year-old night-shift ER nurse. A tech recently had told Lara that just before shift change, he had seen Fatima roll a needlebox cart into a storage closet. That’s a good idea! Lara couldn’t help thinking, understanding immediately that Fatima was desperate enough for partially used vials of narcotics that she would stick her hand into a box full of used needles in a hospital that treated many patients with HIV and tuberculosis.
The tech had followed Fatima into the closet and turned on the light to see Fatima’s hand in the needlebox. “What are you doing?” he asked.
Fatima immediately withdrew her hand. “Uh, the box was full, so I’m putting it away,” she said.
“So why’s your hand in there?”
Fatima mumbled an unintelligible excuse and the tech had let her go.
During Lara’s next shift, she was heading toward an RBC meeting when she saw Fatima in the hall. Lara recognized the signs: Fatima was pale, sweaty, and sluggish. Her face had a greenish sheen. Oh my God, you are dope sick, Lara thought. She played dumb. “Hey, Fatima, isn’t your shift over?”
“I got called into the office. When people don’t like you around here, they make stuff up about you. So I’m here to tell my side of the story,” Fatima replied.
She probably doesn’t even see it, just like I didn’t, Lara thought. She wanted to help Fatima, to tell her that she could still turn herself around without losing her nursing license. But she wasn’t sure how to convey that she knew about her habit. Lara worried that Fatima could accuse her of slander and get her fired. Fatima was barely an acquaintance; they passed each other in the hallway only occasionally during shift change.
Lara decided to ask her Thursday night group what to do. For years, her group of eight women—all friends from NA—met once a week to check in with each other. They could tell Lara how to handle the situation.
But at the network’s next meeting, Lara didn’t have a chance to discuss Fatima. The bulk of the dinner was spent consoling a woman whose father had died, so Lara didn’t mention some recent disappointments in her own life. She had learned that she wouldn’t be able to volunteer occasionally as her kids’ school nurse after all. School nurse volunteers were required to take a CPR course run by the county, but the course was offered only once per semester and Lara wasn’t able to attend that day. The county wouldn’t allow Lara to work in the school even though she was a CPR-certified nurse who cared for critical patients regularly.
Also, Lara’s marriage was deteriorating. John was openly flirting with other women and gambling again but denying that he had a problem. Sometimes Lara thought about leaving him, but she didn’t know how her family would manage. Even though he still wasn’t working, Lara couldn’t fathom being a single mom on a nurse’s salary without having John around for childcare. “If the kids say, ‘Can I join T-ball’ or ‘Can we go to the movies,’ I don’t want to be in a place where I can’t give them that basic childhood stuff,” she said. She soldiered on.
JULIETTE PINES MEMORIAL, November
Juliette was in the doctors’ back office, joking around with Clark Preston. The doctors’ office was a relatively large room with five computers spread across a U-shaped desk. It wasn’t unusual to see doctors flirting with the cute nurses back there. Juliette, who had good working relationships with most of the doctors, ventured into the office when she had questions about patients or to hang out with Clark, who liked the same sports teams and TV shows she did. Clark usually had a funny video or photos of his dogs to show her.
On Juliette’s way out of the office, she saw Dr. Fontaine and red-haired Nancy—the nurse-dating womanizer and his former girlfriend—sitting across from each other in close quarters. Nancy, who was on the phone, was pointedly looking down so that the doctor wasn’t in her sight line. She wouldn’t meet Juliette’s eyes, either.
It was a shame that Juliette couldn’t forget that Dr. Fontaine had dated three nurses behind Nancy’s back. He was otherwise a charming and skilled practitioner. She shook her head and went to the nurses station, where she was charge nurse for the shift. After checking the boards, she went to triage to help out.
When a patient came in with abdominal pain, Juliette flagged Lucy, the tech assigned to triage, in the hallway. Lucy was a lazy tech who got away with dodging her responsibilities because she occasionally babysat for a few of the supervisors. Once, when Lucy had called in sick, her Facebook page revealed photos of herself at a festival.
“Please put an IV in this patient. He has abdominal pain,” Juliette said, gesturing to the 55-year-old patient in a wheelchair. The man was vomiting into an emesis basin.
Lucy blinked at her. “Is the patient going to go to the waiting room?” she asked in her thick Dominican accent.
“Yes, but not for long. He’ll be within eyesight of triage. He’s vomiting, so we have to give him Zofran, and then he’ll go to a room as soon as it’s ready.”
/> Lucy shrugged. “I can’t put an IV in him because he’s not going straight back to a room.” She turned to walk away.
“Lucy, the patient needs your help now! He’ll go back to a room within five minutes, but I have to assist with another patient,” Juliette said.
“No, I can’t do it.”
“You can!” Juliette insisted. “You can put an IV in him because he desperately needs it.”
Lucy ignored her, as if she didn’t understand; she seemed to have selective comprehension of the English language. She did this frequently to Juliette, even though techs were supposed to follow charge nurses’ instructions.
Juliette exploded, upset about Lucy’s treatment of the patient. “Oh, will someone just say it to her in a language she understands?” She regretted the words as she said them.
Gabriel, the secretary, whirled around in his chair and stared at Juliette. Lucy stomped out to triage. Erica, the senior charge nurse, hurried after Lucy to calm her down. “Bad move. That was the wrong thing to say,” Gabriel said.
“I know, I’m sorry. It was so wrong,” Juliette said. “I messed up. Should I go out there now?”
“No, just leave it alone.”
For the rest of the day, Lucy ignored Juliette even more blatantly than usual. “Where’d the patient go?” Juliette asked. “What room is that patient in?” Lucy wouldn’t look at her. If Lucy had a question, she asked another nurse, even though Juliette was charge.
The next day, Juliette went to Priscilla’s office to tell her what happened.
“She’s already been in here and she was crying,” Priscilla said.
“Oh, give me a break,” Juliette sighed. “Lucy was insubordinate before this escalated. Could the three of us please meet?”
“Sure,” Priscilla said. She never arranged the meeting.
The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 14