A dozen things I wish you knew.

There’s lots nurses wish they could say, but can’t; either because we are afraid of hurting your feelings, or losing our jobs. So let me write this without actually putting my name on it in hopes that I don’t get a fiery brown bag full of poop on my doorstep from you or my boss.

Let’s be honest, the healthcare industry is jacked. Part of the SNAFU is the public’s demand for customer service in healthcare and the concept that healthcare is a right instead of a privilege. Here’s the thing, healthcare is a limited resource – we like to think it isn’t but it is. AND, People expect nurses to do all kinds of terrible things and at the end of the day say, “Geewiz, what a great opportunity I have to do this.”

Now, let me be clear: I love my job, love it. I am excited every time I get to go in. I get to work with some of the best doctors, nurses, techs, RTs, PAs, NPs, housekeepers, volunteers, administration, HUCs, housekeepers and on and on. I am one of the nurses who really does say, “what a great opportunity…” However, that doesn’t mean I am blind to the ridiculousness of the healthcare industry both from our end (the provider’s) to your end (the patient’s) and the man (government) in between.

Anyway, here are a dozen things I have put down hoping that it may help you understand a little more about my day-to-day. Next time you think, “Should I go to the ER?” I want you to think about this list. Read it. Stop and say, “do I really need to go to the ER?” If you do, come on down and let us take care of you. If you don’t really need to, go to your family doc and hash it out there.

1. Your doctor may be incompetent. Although I work with some of the best doctors around, I have learned that doctors (of every flavor from family practice to surgeons to specialists) are like chefs. Some are great and make a five-star meal from items found in a bachelor’s fridge. Others can’t boil water without ruining it. So, ya. Your doctor, or the doctor we turn you over to may be an excellent one, or a crappy one. All the same, I can’t tell you more than, “you’re in excellent/good/great/wonderful hands,” because I will get fired if I tell you the truth and say, “I wouldn’t let him touch my dog.”
   Along this same line, your life is in my hands, not the doctor. In other words, the doctor didn’t save you, I did. Ever notice how often the doctor takes credit (or how often you give him credit)? Behind the scene it may have been me there telling the doctor, “Hey, they don’t look good, can I…” or it was me that performed the duties that resulted in your recovery. Sure, credit where credit is due, the doctor gave the order; but who wins wars, generals or soldiers? Food for thought.
2. I am often a translator from doctoreese to English, ask me what he just said if you didn’t understand the doctor. He/she speaks a different language to make himself/herself sound pretty cool, and guess what, they do sound cool. They are cool and they worked hard to become that cool, but man, it’s not cool when we can’t understand it. I have had several patients nod idiotically at the doctor while he/she was explaining results/procedures/ect. After the doctor leaves, the patient turns to me with that stupid blank stare and says, “what the hell did he just say?” Thing is, you should ask questions, you should ask for it to be watered down to a level you understand. Physicians spent around a decade trying to become a well-versed provider. Nurses spent at least 3 years, in school, learning how to do their job. Part of their job includes translation. So ask, please. It makes us (nurses) feel better about you and your care. When you don’t ask, I assume you’re not getting it and don’t care.
3. You’re a moron. WebMD, Google, Wikipedia, or any other internet source can’t diagnose you, and if they do, they’re probably wrong. The internet is great, and gives us TONS of information. BUT, it’s not always right, and often causes more drama than not. Here’s the thing, you should question your care, we should have answers. But don’t think, just because you read it online, you suddenly know – you don’t. And while I am on this tangent, no, vaccines do not cause autism!
4. If I walk in your room and you’re playing on your cell phone, you’re pain isn’t that bad – it just isn’t. If you want to see pain, stand up, walk with me over to the Trauma bay and see the patient who was in the car wreck and did a superman through the windshield because he wasn’t wearing a seatbelt (btw: wear your seatbelt). Don’t get hung up on the pain scale. I will treat an 8 the same as a 6. I use the scale to understand if your pain is getting better or worse, not how much you’re suffering. Pain is subjective and I am taught to think, “pain is whatever you say it is” but if you’re telling me that you’re a 10 out of 10 but you’re falling asleep in the bed, guess what, I don’t believe you.
   This is a hospital full of people sick and dying, not a hotel (oh and also, the hospital is the dirtiest place to be, don’t let your kids play on the floor!). If you have come to escape the weather or lay in one of my beds, just think: The person who was in the bed before you had DIC and bleed from his eyes, nose, ears, penis, anus, and mouth until be bleed so much he died. Or it was someone who was covered in MRSA. Now… lay comfortably in the bed and rest. I’ll be right with you. Oh ya, come to think of it, that last patient complained a lot less than you, which brings to mind that the sicker you are, the less you complain.
   Then, when you do come, for the most part, don’t expect a cure from the ER. We send a lot of people home from the ER not totally sure what’s going on, you’re case may be no different. Roughly 65% of the abdominal pain complaints go undiagnosed, we don’t have a good answer for you, sorry. But what we do know is that it won’t kill you. That’s what the ER does; we find the things that will kill you fast and stop them, fast. If we don’t find anything, good news. However, I am shocked by the amount of people who get upset with me because we didn’t find anything. Hey, that’s good news man! You’re going to be ok. I know it’s frustrating that we can’t tell you why you hurt, but trust me, I would rather give you the news that you’re going to be ok, than tell you that you have cancer; that’s a crappy conversation, trust me.
5. You’re abusing the system, and I am paying for it. We all know the Healthcare system is crap, and it may get worse. But when you treat the ER as your primary care center (your family doctor), you’re doing it wrong. For the most part, the people who do that are the people who don’t have insurance and have learned that the ER can’t turn anyone away until they have been seen, regardless of ability to pay. So who then will pay for the visit of the individual who comes in complaining of chest pain (btw it’s acid reflux = not an emergency) who called the ambulance who transferred the patient to the ER and after a $4000 work up and extensive nurse care? Me. I can explain why it’s me in the end, but really, I am paying for it. Yes, I get paid to take care of anyone who comes in and I get paid the same if you’re admitted to the hospital or sent home. But I don’t get paid what I am worth because the system is abused and is broken. I get it, but please, for my sake and sanity, don’t abuse the system. I don’t like it.
6. I multiply how much you say you smoke/drink/do drugs by 3, that’s probably a little more accurate. What you do at home in regards to these items affects your care. Don’t lie! I can spot a meth addict, or someone high on heroin from a mile away. If I smell pot on your clothes and you say you never smoke, I am going to do a drug screen and call you on it. Thing is, I will find out what the blood alcohol and serum drug levels are, so just tell me so I don’t prolong your care. And yes, smoking is bad for you, so is drinking. So stop. On the subject of lying: your medical records (including the narcotics you’ve been prescribed) are computerized – don’t lie about it! If I, or the doctor, comes in and says, “Sorry I can’t give you any narcotics for the pain,” there’s a good reason…
7. I spend more time charting on you than I do in your room with you so in case you sue I am covered. I am shocked that I spend twice as long on your chart than I do in your room with you. How terrible is that!? Shouldn’t I be in your room looking at you, assessing you, treating you? Instead I am at my desk charting about what I did in your room (my short visit). This is due to the feds, and to the people who have sued doctors, nurses and hospitals. So to offer protection to you, and ourselves, we have to chart… a lot! Sorry. I am not on Facebook. I am not checking my email. I am frantically trying to keep up on the charting, the orders, your demand for ice, and trying to plan my bathroom break.
8. So what’s taking so long you ask? Let me explain… allow me to carry on to the idea that your emergency isn’t my emergency. I would love to be able to tell you about the patient next door who is having a heart attack, the other having a stroke and my fourth patient who is literally dyi… is dead. I am sorry I am late coming into your room to talk about your belly pain that’s been going on for several days. There is a process called, “running the board” that I would be happy to do with you at some point during your visit. This is when I go through all the other patients in the ER that are sicker than you, or who are dying faster than you are. Fact is, the ones who are going to die that fastest are the ones I pay most attention to. If I’m not in your room a lot, it’s a good sign about your health. Along that vein, if it’s been going on a while, the ER isn’t the palace to get it fixed. If you have been able to live with this for more than a day, you need to go to your family doctor and get it sorted out. The ER is for Emergencies. Emergencies are defined as “a situation that poses an immediate risk to health, life, property, or environment.” Immediate is the key word there. So consider, do you need to call 911 about the food poisoning you think you have from Taco Bell? And do you need to come to the ER about the toothache you have had since March? Seriously.
9. I may look calm, but I’m freaking out. There have been a lot of times I have looked over the bed rail at my patient and thought to myself, “oh crap, she is dying… fast” but I have tried to keep the smile on. I want people to feel comfortable and at ease in my care. That’s hard to do if I look at them and say, “you’re looking bad, I’m not sure you’re going to make it.” So, if you see a calm nurse, it’s not because they have ‘easy’ patients, it’s because they have learned how to mask the freak out. But if you (as the patient) ask me, “have you ever done this before?” my answer is “Yes, I’ve done this before”, even if I haven’t. I know I am lying to you, but I wouldn’t do it if I didn’t feel like I could. The real scary life threatening stuff nurses can do, we always have a double check. So… ya. I can do it, even if it’s my first time. Chances are, I will succeed. I could fail…
10. I may know more about your case than your doctor does, but I can’t tell you anything about it, and that’s a little frustrating for me, and for you. I have access to the same labs, xrays and documentation as the doctor and usually I see it before they do. That being said, I know (for the most part) what we are looking for, and therefore know what’s going on – sometimes before the doctor does. However, if you ask me, I have to say, “The doctor will read the results and make a plan with you about it.” It’s beyond my scope of practice to tell you about you. We call that a diagnosis and nurses aren’t supposed to do it. Ya… I know what’s going on, but I can’t tell you. There’s a funny (funny because it’s true) saying that goes something like this, “Do you want to talk to the Doctor in charge of your case, or to the nurse who knows what’s going on?” Truth in that statement.
11. I may have forgotten about you, sorry. Don’t hesitate to hit the call light, that’s why I gave it to you. I don’t usually, but sometimes I do forget about you – or rather, the last time I saw you. Time really flies as a nurse, and you know how long you’ve been waiting to see me. I tried to give you a timeframe, but if you need reassurance, let me know. I will say, however, if you abuse that call light just because you haven’t seen me in 10 minutes and you need your pillow fluffed, or help finding the Disney Channel for your kid you’re letting play on the floor (I thought we went over that issue), I will rip the call light off the wall and only come see you when I have to. Don’t abuse me.
12. I have feelings too and I may cry at home, or even at my desk, about you. I care, if I didn’t I wouldn’t do this job. I care that you’re in crisis, I care that you hurt and you don’t know what’s happening. I understand frustrations, and try my best to minimize them. When things are scary, or upsetting, I am happy to a shoulder to cry on, but I am not your punching bag. It tends to be the case that those who are kind to me, get kinder treatment. Be kind, it’ll come back to you. You should know that as a nurse, I sacrifice for you; nurses hold our bladders for hours at a time to make sure the charting on you is an accurate record of your care. We skip lunch breaks to make sure that your IV tubing is freshly changed so that it won’t cause you a blood stream infection. We kiss our children goodbye and assure them that Santa will still find them at grandma’s house on Christmas Eve, because daddy/mommy has to work night shift tonight. The long and short of it: Be nice or go away.

Sincerely, your ER nurse.