Juliette bought an apology card and a box of chocolates from the gift shop. When she tried to apologize, Lucy refused to accept them.
“I don’t need a card,” Lucy said.
“I’m trying to say I’m sorry,” Juliette said, genuinely trying to make amends.
“What you did was wrong.”
“Yes it was. I’m trying to apologize,” Juliette repeated, still conciliatory.
Lucy stood up and walked away. Juliette left the card and the chocolates on her computer.
Weeks later, Juliette shared this scenario during a continuing education workshop. She felt awful about her mistake, but she worried that Lucy’s refusal to interact would affect patient care. “Lucy hasn’t spoken to me since,” she said.
“What Lucy was doing, before the incident and after you apologized, is a form of bullying that is common in nursing today,” the facilitator said. “Ignoring is a form of bullying because you’re blocking that person out. It doesn’t matter if you don’t like somebody. That’s fine. You don’t have to. But you need to be cordial to and communicate with that person at work.”
Juliette felt helpless, but Priscilla wouldn’t do anything about it. Priscilla was too afraid of confrontation to act like a manager and diffuse the situation. In Priscilla’s realm, bullies and slackers went unpunished, and staffers who did go beyond the call of duty weren’t recognized. Priscilla didn’t reprimand Juliette; in fact, she told Juliette that she had been right about the patient and encouraged Juliette to be charge nurse more often.
Shortly after that incident, Erica, the senior charge nurse Juliette genuinely admired, resigned from the ER to take an administrative position at another medical center. “I’m so tired of the bullshit at this hospital,” she told Juliette. Assignments and rule enforcement were too subjective, she said, and the gossipy atmosphere was poisonous.
“You should apply for my job, Juliette,” Erica said. “You do a good job when you’re charge.”
Some of the nurses thought Juliette would apply for Erica’s position, but Juliette didn’t want it. The job was too stressful. Besides, Juliette didn’t care about prestige or hierarchy; she preferred to help patients as a bedside nurse. Rumors spread that Charlene was lobbying for the position to be renamed “head charge nurse” to emphasize that Charlene, as nurse supervisor, had seniority. Juliette had heard that Bethany, a talented nurse relatively new to Pines, was applying. Juliette liked Bethany. If Bethany was sitting at the nurses station and saw another nurse walk by, she would automatically ask, “Do you need help with anything?” Bethany was a thorough nurse, as well. Juliette had passed by patient rooms multiple times and seen Bethany conducting a careful full head-to-toe assessment. Juliette associated Bethany with the clique, but she was upbeat and nice to Juliette.
One day, Juliette checked Facebook while sitting at the nurses station. “Let’s take the kids on the ferry this weekend!” a clique member had posted on several nurses’ walls.
“That clique is so mean,” she muttered.
“Don’t feel badly, Juliette.” Juliette looked up. She hadn’t noticed Bethany sitting nearby.
“When I started working here, I had never, ever seen cliques like the nurses in this ER,” Bethany said. “I was amazed.”
Because Bethany lived in the same neighborhood as the others, and because she was the most beautiful person in the ER, Juliette had assumed that the clique had embraced her.
“Aren’t you in it?” Juliette asked.
“Not at all,” Bethany replied. She had heard other nurses talking about her behind her back. “It feels like no one is on my side,” she said. “I don’t have work friends, so I just go home after work and that’s it.”
Last month, several members of the clique were standing around the nurses station talking about a party. Bethany couldn’t believe they unabashedly discussed the event in front of her. “So,” she said, “are you inviting anyone else?”
“Oh, no,” Anastasia answered. “It’s a thirtysomething party.” Bethany was 29.
“I see it all the time,” Bethany said now. “They’ll make their plans and purposefully discuss them in front of me, while excluding me.”
Juliette felt a rush of camaraderie. “Same with me! I have a seven-year-old daughter and you’d think they’d include me in the kids’ group playdates, but they don’t,” she said. “I can’t believe they exclude you, too.”
Juliette thought about this conversation for days. At least they seemed to like her better than Charlene, who still believed she was a part of the group. One nurse had admitted to Juliette that she was nice to Charlene only so that she would get good evaluations.
Juliette didn’t go out of her way to help Charlene anymore. On a busy day when Charlene was supervising the unit, Juliette deliberately focused on assisting other nurses instead. Charlene’s power-tripping, disrespectful treatment had worn Juliette down to the point of vindictive inaction. “On a day when the ER was crazy, I enjoyed watching her run around and be completely scattered,” Juliette admitted to a friend. “I didn’t triage more ambulances when I could have. There was a patient she could’ve moved out of my zone into the psych pod. That would have given her another bed. She didn’t catch on to it and I didn’t volunteer the advice. It’s not to the point where any patients would suffer; I would never do that. But she has destroyed any sense of loyalty I would have had to anybody else.”
It was common at Pines for nurses to plainly avoid helping coworkers they didn’t like. For example, when an ambulance arrived, usually one nurse would triage and others would help the assigned nurse move the patient to the bed, get him on the heart monitor, take vitals, and start an IV. But if the assigned nurse was disliked or lazy, nobody would help her unless the patient was in danger.
During Juliette’s evaluation, Priscilla told her that on the scale of 1 to 3, Juliette had scored several 2s and a few 3s, averaging about 2.6. “You’re doing an excellent job. I’m very happy with you,” Priscilla said. “You showed a lot of growth over the year, you help out your team members, you’re always available. You anticipate patients’ needs, you talk to the doctors about what’s needed, and you advocate for patients. The only thing is, you have to be on time more often.”
Juliette left Priscilla’s office pleased. She was also relieved that she had listened to Lara. Since her conversation with Lara, Juliette had had a dozen opportunities to take Dilaudid from the ER. It was amazing how many nurses “turn a blind eye when you say, ‘I’m going to waste this with you,’ ” Juliette said. But she didn’t do it. If her migraine was bad enough to require narcotics and Tim wasn’t home, she would take a cab to the ER. She had promised Lara she wouldn’t take anything from the hospital, and she would stay true to her word.
SAM CITYCENTER MEDICAL, November
At 11:00 p.m., nursing home attendants brought an elderly woman into the ER because she wasn’t eating. When Sam checked the woman’s vitals, she realized that the woman wasn’t eating because her pulse was thirty-five beats per minute (normal range is between sixty and eighty). Also, the woman was breathing too rapidly, wasn’t moving one side of her body, and most likely had a urinary tract infection. By now, Sam was experienced enough that she could tell when a patient had a UTI because “they just have that smell.”
Sam started an IV, drew labs, and, forty-five minutes later, took the woman to get a CT scan. The scan showed that the woman had internal head bleeding. William came in to check on Sam. He seemed to know intuitively that she was worried because she’d never treated a patient this sick.
He reviewed the woman’s chart. “Okay, Sam, you take care of the meds, I’ll document.” He helped Sam assist the patient’s intubation, put on restraints (in case the woman woke up and tried to rip out the tube), and titrate (adjust the dose of the patient’s medication). He showed Sam new techniques for inserting a Foley catheter, even though, as Sam put it, he w
as “not a Foley person.”
When the ICU was ready, Sam called in report while William emptied the Foley bag and checked the patient’s vitals. On the way upstairs, Sam looked at the clock: 1:30. William—the charge nurse, who was not supposed to have any patients—had helped her for nearly two hours. Sam was so grateful that she didn’t get annoyed with him when he resumed his usual teasing.
He tugged on her ponytail. “So how are things going with Dr. Spiros? When are you going to see him?”
“Geez, why is this such a big deal to you?” Sam said.
“Oh, well, you know, I look out for my people,” William replied.
The next night, when Sam arrived at the restaurant first, she had second thoughts while waiting for Dr. Spiros. She wasn’t nervous because he was older; she had dated older men. She was nervous because he was a doctor. At her hospital. Why are we doing this? she thought. How did this whole thing happen, anyway? Sam knew women who became nurses specifically because they wanted to marry a rich doctor. Sam was not one of them. Actually, she felt “a little weird being that stereotypical nurse going out with a doctor.”
She spotted him as soon as he walked in, wearing dark chinos and a collared crimson shirt, and saw that other women in the room noticed him, too. He looks good, Sam thought, and then, Oh my gosh, that’s Dr. Spiros right there. I mean, Dimitri.
The date started off slowly. As they awkwardly talked about work and family, Sam narrated in her head. And now I’m going to ask you a question, and you’re going to answer, and then you’re going to ask me a very similar question. They found their groove by the middle of dinner, at least enough so that Sam was convinced that Dr. Spiros was charming after all. They found that they both were fervent football fans and were able to banter about their rival teams. “It’s rare to find a woman who’s into football,” he said.
At the end of the night, Dr. Spiros smiled warmly. “Well, hey, let’s get together again.” They set a second date for two weeks later. Then he initiated Potential Hug Sequence. Sam couldn’t tell if there would be an attempt at a kiss or whether the hug would be one-armed or two, so she leaned in gracelessly and they ended up patting each other on the back. Instead of saying something to diffuse the awkwardness, Sam shrugged and walked toward her apartment, thinking, Yep, just let the awkwardness keep rolling because I’m awkward like that.
Sam didn’t think there was chemistry. She was surprised he wanted to see her again. The evening had been fun enough, although they didn’t seem to mesh. But what could she do? As she told a friend, “I’m not good at letting people down gently. I can be efficient with a sledgehammer, but how could I do that to a doctor I work with?” At least dating a doctor, if that’s what was happening here, made her job even more interesting.
The following night, Sam realized she wouldn’t have time for “interesting.” When she arrived at Citycenter, 105 patients were already on the board, meaning each nurse had double the maximum patient load. The ER didn’t even have enough equipment for the staff to properly do their jobs; there were only ten bags of saline in the entire department. Sam was the only nurse in Zone 3 because the other assigned nurse had not come in. Zone 2 also had only one nurse. Sam wondered whether her absent coworkers were the latest nurses to quit under Victoria’s reign. If I can make it here, I make it anywhere, Sam thought.
For the first hours of her shift, Sam raced among her nine patients while, as a tech on her way in told the staff, Victoria (the ER director) and the nurse educator were across the street eating dinner. Both Victoria and the nurse educator had been longtime nurses who easily could have helped out on the floor.
Two of Sam’s patients were seriously ill but had been mistriaged; they should have been assigned to Zone 1. One of them had diabetic ketoacidosis, or DKA, a difficult condition for a nurse to handle alone. Sam was supposed to give the patient at least five liters of saline and monitor his insulin drip by doing hourly finger sticks. She managed to draw his blood only approximately every ninety minutes, and even so, that was because his room was easily accessible, across from the nurses station. He should have received one-to-one care.
Because of those two patients, Sam couldn’t visit her other patients for three hours. She didn’t have time to go to the bathroom for eleven hours. She was so tired that she caught her foot in the cords of a portable vitals machine and face-planted directly in front of the nurses station. The charge nurse immediately quipped, “Oh no, we can’t lose another nurse!”
Midshift, an ER resident made a miscalculation and ordered Sam to turn off the patient’s insulin drip. When the DKA patient’s ICU doctor came downstairs, he was furious. “Why has he gotten only two liters of fluid? Why is the insulin turned off? Why haven’t you taken a finger stick in ninety-six minutes?!” he yelled, gesturing to the empty saline bags still attached to the man’s IV.
“I’m sorry but I have seven other patients right now,” Sam said. She was still the only nurse in the entire zone. “I wanted to rip this guy’s head off!” she said later. “What did he think I was doing, sitting around eating Twizzlers and painting my nails? I had people in the back holding room with chest pain and shortness of breath who I hadn’t seen for hours. I had to make sure they were still breathing.”
The ER resident and senior resident heard the commotion and dashed into the room. They tried to explain that the ER was overcrowded and that the nurses were short-staffed. “It doesn’t matter! This is an ICU patient!” the doctor yelled. “He needs one-to-one care!”
Sam slipped out of the room to attend to her other patients while the residents calmed the doctor down.
The next night, Sam was assigned to Zone 1. As busy as it was, she was thrilled at the chance to work with tough patients. The charge nurses usually assigned her to Zone 3, where Sam didn’t feel she was learning as much as she could. Again, nurse numbers were down. An anesthesiologist she worked with was so taken aback by the unreasonable number of patients in the ER that he kept muttering, “This is so unsafe. Someone is going to die; this is so unsafe.”
An IT guy, who was in the building to assist with the transition to a new computer system, caught Sam in the hallway. “Um, I think that nurse needs help.” He pointed to a patient room.
Sam walked into the room to see a frantic young nurse even less experienced than Sam working alone on a complicated patient. Triage had sent back a patient with a heart rate of 150 beats per minute without an EKG. The patient was a train wreck: He’d had a seizure, couldn’t follow commands, and was jaundiced. Sam helped the nurse get a rectal temperature of 102, then went to find the ER doctor.
Sam found Dr. Spiros outside another patient’s room. “Hey, can you order some Tylenol for Mr. Rhodes?” A fever could cause a high heart rate.
“I don’t think he can swallow anything,” Dr. Spiros replied.
Sam gave him a “don’t be dense” look. “No shit, Sherlock. I want it rectally.”
Dr. Spiros laughed and gave her the order.
William, the charge nurse that night, saw them laughing together and followed Sam to her next patient room. He typed the patient’s information into an EKG while Sam connected the leads. “So how was your date with Spiros?” he asked her.
“It was fine. No big deal. We just hung out.”
“What did you wear?”
“Jeans. A sweater. Boots. Why?”
William shrugged. “It makes a difference. Do you like him?”
“I don’t know. It’s too early to tell,” she said, dodging.
William looked at her for a long inscrutable moment before leaving to check on other patients.
At the eleven o’clock shift change, Grace, an older nurse, tried to transition her patient to another nurse. The younger nurse refused because she was overwhelmed. Grace explained the situation to Sam.
“Are you kidding me? Everyone’s overwhelmed!” Sam said. Sam had been overwhelmed plenty of
times since her first day, but she kept her head down, focused on her sickest patients, and never once refused to take another. Sam took Grace’s patient without reservation. Grace had been working at least eight hours longer than Sam, and had every right to hand off her patients and go home. If Sam didn’t take the patient, he would be assigned to the inexperienced nurse with Mr. Rhodes, the sickest patient in the ER. Sam’s patient total was now at ten, the most of any nurse. “We have to work as a team,” Sam said. “On bad nights like this, teamwork is even more important than usual.”
Sam believed that nursing schools should instill the value of teamwork, but that hadn’t been her experience. The phrase “nurses eat their young” was, to Sam, “the understatement of the century.” While some of her nursing instructors had been friendly and helpful, many of her clinical instructors were not.
Early on in her schooling, when Sam hadn’t emptied a patient’s Foley, an instructor yelled at her about it in front of the other students and nurses. “You’re screwing up! How could you not empty the Foley bag? That’s gross!” the nurse yelled at Sam, her tone nastier than her words.
“Well, no, I didn’t empty the Foley. I didn’t know I was supposed to. We’re only a month into clinicals,” Sam had managed to say before dissolving into tears.
That instructor made other students cry and once screamed at a pregnant student so loudly that the woman left class early with chest pains. Sam stuck with the program. Other aspiring nurses did not.
MOLLY November
South General Hospital
Molly was assigned to a patient who had developed a 104-degree postoperative fever after a minor surgical procedure. Molly introduced herself, then started an IV to deliver fluids and medicines. An hour later, when she checked on the patient, the woman was feeling better. In a tired, crackly voice, she said, “Thank you, Molly.”
Molly couldn’t believe it. In ten years, no patient had taken the time to thank her by name. That small gesture made Molly feel important, “not in the world, but to that patient,” she said.
The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital Page 15