I graduated with an English degree in 2009, right at the beginning at what at that point was being called ‘a once in a generation recession’ which, you’ll excuse me while I take a few minutes to laugh, cry, and barf at the same time. After spending a year bumming around, I realized I needed to go back to school and get a degree with a much more direct career path. Something that would be fulfilling enough to let me write in my free time (because I don’t know if you know this, but a great many minimum-wage, service industry jobs are so physically and emotionally draining that even thinking about participating in a hobby after work can cause cramping in the leg and lower abdomen area). My mother’s been a nurse since the eighties, so I figured why not? The fact that she choked on her lunch when I said I was thinking about getting a nursing degree might have been a warning sign.
After a year of doing pre-req courses (you’ll be shocked to learn an English degree isn’t loaded with the base science courses needed for a BS) and sixteen months of nursing school – the hardest sixteen months of my entire life, by the way. It was an accelerated course for people who already had a degree in something else and it was brutal. By the end of the second semester I was having panic attacks and crying on the reg, and my heart went into palpitations so often I could identify when I was trigeminy – I passed the NCLEX, got my nursing license and my first nursing job. I was a nurse for seven years, five years in inpatient and two years out.
Why, you are probably asking, am I the nurse you should be afraid of? Well, because of a single little word in that last sentence.
Was.
I was a nurse.
And there’s about to be a lot more of us.
Nursing Wasn’t Exactly Fun Before COVID
COVID-19 is 1000% the reason I think we’re staring down the barrel of a staffing shortage across all medical professions, and we’ll get to that, but first we need to go over what nursing was like in the Before Times. In short: it was a borderline-dangerous shit show.
(I’m going to be focusing on my time as an inpatient nurse, because inpatient is where, like, 97% of the problems lie. Outpatient facilities are where inpatient nurses run to when they’ve torn out all their hair.)
The Patients
You may be shocked to learn that the patients are a very small percentage of any nurse’s stress level. We all became nurses because we want to help people. There’s an understanding that when a patient is rude to you, it’s never really about you. They’re sick, they’re scared, they’re turning that fear into anger and you’re the closest person around. Sometimes it’s whatever they’re sick with that turns them into people they’re not. My first nursing job was on a liver unit, and if you’re looking for motivation to cut back your drinking go ahead and google ‘hepatic encephalopathy.’ I’ll wait.
That doesn’t mean all patients are saints. The act of putting someone in a hospital gown does not turn them into Mr. Rogers. Sometimes, shitheads need healthcare. And they continue to be shitheads even to the people who are trying to help them. You’ve got your:
- Drug seekers, most of whom are Not Subtle and also think that nurses are not only not hyper-aware to their bullshit (we are) but also that we’re drooling idiots who can’t even comprehend what they’re up to. “I’m at a ten on the pain scale,” they say without me asking as they calmly type away on their phone. “Tylenol never helps my pain, the only thing that ever helps is a mix of Dilaudid and Benadryl. IV only.” Riiiight.
- Classic Narcissists. You know those people who are super shitty to service-industry people? Like, the lady in front of you at the Dairy Queen screaming at a teenager because she didn’t get enough nuts in her parfait? Yeah, those people are also shitty to nurses and care techs in the exact same ways. We’re all there to serve Her Majesty and if we don’t do it the way she wants, it’s time to get a-screaming! I once got chewed out by an old lady for not bringing her a blanket fast enough. The fact that I had been next door coding one of my other patients meant nothing to her.
- Malingerers, who find any and all reasons to stay in the hospital for as long as possible. Sometimes it’s just because they like the drugs and the snacks (old joke: what does RN stand for? Refreshments and Narcotics). Sometimes it’s because they like the attention. Ask any nurse who’s been working for a few years and I bet they’ve got a handful of stories they can tell you about people who almost definitely had Munchausen or Munchausen-by-proxy.
Before we move on, I’m going to give you an insider tip: nurses will generally work two to three shifts in a row, and when doing so we prefer to get the same patient assignment every night. It’s called ‘continuity of care’ and it’s better for everyone around, because you can get a sense of what a patient is like and anticipate their needs.
Sometimes, though, a patient is so fucking stressful we can’t handle them for more than one shift. Usually, this is because they are one of the sickest patients on the unit and need a lot of attention and care. Just as often, though, it’s because that patient is a shitty human being and if a nurse has to go in there two nights in a row they’re going to smother them with a pillow.
So, if you are ever hospitalized, don’t require a lot of care, but notice that you never have the same nurse twice? You are being such a piece of shit that the staff is rotating you out so no one quits on the spot. Fuck you.
Other Nurses
Think of the people you work with, whatever sort of business in you’re in. Do you like all of them? Are they all good at their job? Do you wonder, sometimes, how Bob from accounting got the job, or even how he finds a doorknob to get out of the house in the morning? Are there some people you would jump out of a window to avoid?
Despite the idea recently turned into a rallying cry that NURSES ARE HEROES!!!1!!, we’re not. We’re people at a job, just like you, and some of us suck. In all the ways your coworkers suck. Incompetent. Lazy. Mean. Stuck-up. I knew one nurse who worked on the opposite shift, and every time I got patients from her she would start with, ‘I fixed them for you.’ I usually spent the next three hours cleaning up the mess she made. Another nurse I refused to give any patients to at all to because she was such a bitch to everyone. Another nurse clearly had an active meth problem and it took the hospital literal months to find cause to fire her (on two separate occasions she ran away from me mid-report because she realized she had left her car running in the parking lot).
Most of the nurses I worked with were great, but we’re just people.
The Real Villain: Administration
I could tell you stories for days about shitty patients, shitty nurses, and shitty doctors I’ve had to deal with in just five years, but this is where most of the problems with nursing lies.
If you’re ever admitted to the hospital, I’m not talking about anyone you will ever meet. If someone ever walks into your room and introduces themselves as the unit manager or the nursing manager, they’re not it. I’m talking about healthcare administrators two or three or four levels above them. People who have not actually been face-to-face with patients in years, making absurd and inane decisions that look good on paper and in press releases but fail when implemented in practice. Decisions where the bottom line isn’t the patients, but the money.
Unsafe Staffing Ratios
In five years of inpatient nursing I never regularly had the amount of patients I was supposed to have. I was PCU, or step-down, and I was always promised three to four patients, sometimes five patients if we had to stretch. Turns out nursing is always in a stretch. When I quit inpatient, Med-Surg nurses in the same hospital would get up to six patients. Even ICU wasn’t safe. Due to the intensity of what an ICU patient needs, an ICU nurse has only been getting two patients since basically forever, but a lot of the ICU nurses in my last hospital were getting stretched to two ICU-level patients and one PCU-level patient who hadn’t managed to move yet. Easier patient? Yes. Safe? No.
HCAHPS
Shortly before I started nursing, hospitals began running themselves on a Customer Service model instead of a Healing Patients model. HCAHPS (H-caps, as we say) are the surveys patients now receive at random after a hospital stay. Hospitals needs high HCAHPS scores to get more reimbursement from Medicare and the like, so they want the highest possible survey scores possible at all times. Which looks good on paper, I guess. In practice, it means, oh, I don’t know, let me pick a totally hypothetical situation that definitely didn’t happen to me multiple times: diabetic patient with a bedtime blood sugar of over four hundred (normal should be between 100 and 140) wants graham crackers and ice cream. Their health tells me I should tell them ‘no’ and suggest something else or just tell them to wait. But this new Customer Service model of healthcare has taught the patient that no one should be saying ‘no’ to them, ever, and they will bitch and whine until someone gets them their God damned ice cream and then I’m calling the doctor later because their midnight blood sugar is now over six hundred and I need specialty orders and now the patient is pissed anyway because I have to wake them up to give them insulin and wake them up an hour later to take their sugar again. And then they end up giving us a bad HCAHPS score anyway. The Customer is Always Right is bullshit, anyway, and it becomes extra bullshit once you’re dealing with patients who don’t actually want to fix their health. They just want their fucking graham crackers and ice cream.
For the record: if you ever get a survey after any sort of medical experience, unless you have an actual issue you want addressed, rate every single thing the best you can. There is no partial credit, any option you choose that isn’t the best is equivalent to rating it zero.
Everybody’s Mistakes Are Your Fault.
Here’s a story I told every graduate nurse I precepted: about a week into starting my second job, a day shift nurse had just gotten on shift. She was still taking report when she started getting calls from one of the test areas. One of her patients – that she hadn’t gotten report on yet, mind – would be going down for a test and needed a medication first. The nurse tried to explain she was still setting up for the day and hadn’t even met the patient, but this person kept calling and calling and hounding her about it until finally she pulled the medication and brought it with her to give the patient while taking her first set of vitals. Turns out, it was wrong the patient. Turns out, the right patient wasn’t even on our unit. They were in the same room three floors below ours and had a similar name. The wrong patient, our patient, couldn’t handle the medication given and died as a direct result. The nurse was ‘gently pushed to an early retirement.’
Nothing happened to the guy who hounded the wrong nurse about the wrong patient.
Nurses are seen as the patient’s ‘last line of defense.’ It’s what we’re told in nursing school. You have to question literally every single order you carry out on a patient to make sure somebody else hasn’t ordered something that will kill them, because they won’t get in trouble. You will. Now remember that nurses typically have more patients than even the hospital acknowledges they should have. Nursing is mentally exhausting.
They tell you in nursing school that nursing is the way to go because ‘we’re in a nursing shortage, so it’ll be easy to get job. Move quick before they fill up!’
The jobs will never fill up. We don’t have a nursing shortage. We have hospitals running on unsafe practices to save a buck wherever they can that churn through baby nurses until they’re burnout, knowing full well they’ll get another crop of graduates every four to six months.
That Was All Before There Was a Pandemic. And Now There’s a Pandemic
I had burnt out on inpatient nursing by the time the pandemic started. Find a burnout quiz online, any one of them, and I had checked all those boxes. Caregiver burnout is real, and it’s dangerous, and the only thing you, as a caregiver, can do about it is recognize when to walk away before you do something. So, I did. I moved to an outpatient procedure area of a major hospital, and after five years of inpatient it was a fucking dream.
A year and a half after I’d made the switch, the pandemic arrived. And I was scared. About the pandemic. About the unit being reduced or shut down. But mostly: I was terrified that the hospital would demand I go back to bedside. Even after a year and half just the thought about going back made my skin crawl. And I wasn’t the only one. In fact, nurses who were comfortable going back to bedside were easily outnumbered by the rest of us who were considering quitting if it came to that.
We’re not bad people. We understood that things were about to get bad and help might be needed. But we had already been used up by the system. Abused by patients and administration, overworked, stretched thin, underpaid. We huddled together in the hall in groups, talking in small voices tinged with barely-held back panic about what we would do if the hospital told us we would be going to inpatient units for the duration. Leaving was a viable option.
I never worked face to face with COVID patients. I managed to get on a call center job phoning people their test results. Then I barely got into a nurse navigator position before the opportunity to quit altogether arose. And I took it without hesitation. Seven years of nursing that I don’t regret. But I’m still glad they’re over. And I’m glad I got out without having to treat COVID patients because GOD FUCKING DAMN.
Now There’s a Vaccine. And People Who Won’t Take It.
It was one thing, trying to save COVID patients in the beginning. Exhausting, yes. Dangerous, yes. Plenty of people who could have been wearing a mask or stayed home, but a lot of people who didn’t have the option to stay home. Who were taking all the precautions they could and got it anyway.
And now.
Now.
Current estimates say that roughly 98.6% of hospitalized COVID patients are unvaccinated. And at this point, roughly ten months since vaccine rollout started in earnest, there are two groups of people who are unvaxxed in America: the people who can’t for medical reasons aka part of the reason the rest of needs to get the shot, and the aggressively unvaxxed.
Most of the stories are about that second group. The people who refuse to get the vaccine. These nurses are facing people who don’t think they have COVID even as they are getting intubated. Families are accusing nurses and doctors of lying about COVID to pump up their numbers. Or demanding that their dying family member get Ivermectin or whatever other nonsense they’ve latched onto, even suing some hospitals to get what they want. And when their family members die, it’s clearly because they didn’t get IV vitamin D or aerosolized iodine or whatever.
Everything I went through five years ago is still happening. Dangerous patient ratios, money-hungry administrations, terrifying patients and coworkers. And now the people these nurses are trying to save are spitting in their faces.
I mean, how much would you be able to take?
Decompensation
I spoke of nurses because I was one, but it’s not only nurses. When hospitals try to save money, every type of medical professional gets fucked. Doctors. Respiratory therapists. Laboratory. The CNAs, oh God, the CNAs. If I’ve painted a stressed-out picture of what nursing is, please know the CNAs (or Care Techs, they go by a lot of names) are going through roughly the same shit with less help and less pay. They’ve all already been bullied for decades, and now there’s another shitty layer on top. Many of them will continue to tough it out. There’s something in them, call it a helping light or simply stubbornness, and even as they are used and abused they will continue to set themselves on fire to keep others warm.
Many others will join me.
They will quit. They will become ‘former.’ Hospitals will have patient ratios that they can’t ignore anymore. They’ll start incentivizing people to become nurses, pay for their school and trap them in a contract. They’ll fill their numbers again, having traded their experienced nurses for baby nurses with higher risks of mistakes. Will it completely break the system? I don’t know.
Let me tell you something about the human body: it is incredibly adept at compensating for disease. As long as something comes on slow enough, and the changes are small enough, the body can adjust itself over and over to continue working even in the face of great stress.
Right up until it can’t. And when the body finally decompensates, it’s usually fast and fucked up. It isn’t the body realizing it can’t take what it’s doing anymore and backing off a little. It’s the body finally realizing that nothing has been right for a long time and completely breaking down.
Too bad the people running hospitals don’t seem to have any sort of medical or nursing degree, or they might already know about that.
High Urban Fantasy Jazz 