Thursday, July 30, 2009

To Live and Die in L.A.

I have just resigned from my first nursing job for a number of reasons. I gave three weeks notice. Sadly, I do not feel relieved. I feel scammed and ripped off, exhausted and abused. I don't feel free. I'll expound more on that next week. First, I must share my lessons learned so that others following in my footsteps can remain modestly protected. Thick skin is understandably and necessary requirement to nursing, however it appears shank proof skin is more the order of the day.

1) Even the "cool" experienced nurses you think you can trust will jab the knife in deep given the opportunity.

2) Everybody has a family and obligations, just like you do, they don't care and as a new nurse, even with identified potential you are still a flash in the pan.

3) Experienced nurses (+8 years) absolutely cannot tolerate being identified as having made a mistake or doing anything that might reveal they are human and not perfect. If you stumble across a nurse who say, has proudly announced that she thinks restraints are unnecessary and cruel while her patient is now holding their yanked out portis subclavian central line DO NOT WANT YOUR HELP

4) An experienced nurse who suddenly befriends you has fucked up amongst the other older nurses and is using you as a surrogate friend until the old guard accepts her back.

5) If you ask for help from an experienced nurse and actually receive it, the service comes at a cost: they will then take credit for all of the work you have performed on the shift until that point, with no shame. NOTE: The exception to this rule is older male nurses. I don't know why but they seem pretty stoked when anyone will just listen to them.

6) If you are suicidal enough to point out an error in logic, intervention, or treatment with an older nurse dumbly thinking they will appreciate this then you will forever be labeled as a "know it all" and "dangerously arrogant" despite the fact that usually, the only patients dying from lack of informed and or supervised care is their own. (Hence the constant phrase: "oh, but he was old")

7) Sadly, the one way to break down most fucked up nurses is to ignore them and be openly hostile. I myself hate behaving this way, it makes me feel dirty and sticky in my soul but after a month the same nurses that would literally ignore a question to their face will be hugging you and be delighted to see you.

8) Escape into patient care and knowledge. When in a confined environment surrounded by jackal infidels the only place to go to is work. Might as well do it well. Do not ask questions from senior nurses as they are inherently insecure and confuse genuine curiosity as an inquisition and threat. One question too many may shatter their fragile sense of competence. REMEBER QUESTIONING IN NURSING SCHOOL? IT WASN'T ABOUT WHAT YOU KNEW BUT HOW WORNG YOU WERE. The field hasn't progressed, trust me.

9) It's a great idea to make allies with interns and residents, usually because they relate more to younger novice nurses than older snappy ones and working together to help a patient becomes an effective, educational , and rewarding experience.

10) If the older crew see you relaxed and making jokes with physician staff they will call you "lazy" and will accuse you of ignoring your patients despite the fact that is exactly what they are doing when gossiping about you. Never mind that. Nobody wants a letter of reference from an old crabby nurse who treats the latest evidenced based research and knowledge with the same disdain as she would the newest thrash metal album from Slayer. She aint buying it.

I wish instead of a LA TIMES 20 part news story about 80 whacked out nurses and how they have fallen through the cracks of diversion, I 'd like to see a story on the tens of thousands of tax paying Californian R.N.'s who get regularly scammed and shorted on their paychecks by gloating big bonused hospital management. (Again next weeks topic)
I feel fucking violated. Not only were their staffing ratio's absurd, but when I found out how my new hospital staffs their ICU I got choked up. Seriously, I choked up.
Patient with a balloon pump: 1 to 1.
Patient on ventilator with ANY pressor going:1 to 1
Patient on CRRT: 1 to 1
Patient returning from any invasive emergent cardiac procedure:1 to 1
Seriously, it made me cry. I've had assignments so unbelievable and harrowing while three morbidly obese shit talking multiple personality snackers loudly predicted any possible negative outcome to my patients. ONE TIME IN A YEAR did I have a 1 to 1. Septic, over 300 pounds, active MI, central in groin and central in R IJ, Multiple blood products, fucking 14 PUMPS! NO shit. At 0430 the supervisor literally grumbled all right, make it a 1 to 1 at which point my other co-workers literally stopped what they were doing and demanded I thank them for RECORDING THE VITAL SIGNS ON MY OTHER PATIENT.
Friends, I have had patients code during report and then been barked at by my supervisor for taking too long to get report on my second patient.
After the interview at my new hospital. I, a man, a dude who is semi-permanently disgruntled, prone to the negatives, a man who relishes the positives when they come, a nurse who gives a shit about his patients because it is the only way to stay sane and true of heart, a father, a husband.
Well, I cried.
I cried for my exploitation, I cried for my patients who got just -enough-to -keep-you-alive-care night after night. I cried for the thousand and thousands of times I signed my names to documents that no one will ever look at, selfish documents to cover some lawyers ass that took unreasonable time from patients rotting with bed sores and their own shit. I cried for my co-workers who just don't get how disgusting it is that one ICU manger can cause so much human suffering and distress to get a fat bonus. Cuz that's the bottom line and it always will be. If you need someone to create abrasive, unethical policies that save substantial money in an environment that requires vast resources, well your soul has a price.
The last few weeks I have been blaming foreign nurses. But I may be wrong. I don't know. I do believe foreign nurses don't bring a whole lot to the profession as a whole. I think they inadvertently bring standards down to the standards they are accustomed to.
  • My new unit has no foreign nurses. Not one. 60% of the staff R.N.'s have CCRN certification. As opposed to NONE in my last I.C.U with 20 more beds , a staff of 60, and most nurses with easily over 10 years experience residing in a level two trauma center. I will never hear report in Tagalog at my new hospital. My supervisors will communicate in English.
I hope that the racial divide that is burning like napalm in nursing will not be present in my new unit. I hate how discussing the fact that foreign nurses is in no way good for American nursing is considered racist.
I have left Los Angeles. I have left my home state of California. Surprisingly, the money is better in a more affordable state. It appears, on first glance, the care is better. It also appears that the treatment I will receive as a professional R.N. will be commiserate to the demands and complexities of my job.
This all, of course, on first glance.