wearing out our welcome

mark my words, we are going to get kicked off of our new floor.

it all started after our 'big move' d/t construction on the old unit.  suddenly for the first time since i've been a nurse, we have neighbors!!  this is nice in the way that it conveniences me when i need a green top or a vial of metoprolol, but strange in that i can't tell which patients belong to us and which are just passing through.  and then there's the whole matter of our unit showing its true colors...

we are hood.  and now everyone knows it.

it started innocently enough, in a baby momma fight that involved weave getting ripped out in the middle of our shared hallway and the screaming of the phrase "stupid ho" loud enough to make the nurses on the other unit come running.  the sheriff showed up and hauled people off to jail, and that was that.

then a week later security showed up looking for some visitors.  when trying to find teenagers who steal food from the cafeteria, apparently our unit is first on the list of places to look.  and sure enough, there they were.  after getting lectured by security and having someone pay for the food, the kids were of course very apologetic and saw the error of their ways.  just kidding.  they actually went back to the cafeteria and threatened the workers who turned them in, leading the sheriff to pay our unit another visit.

a few days later, we had a gentleman who thought it was acceptable to grope at the nursing assistants and call them "baby".  a manager tried to talk to the patient and explain that this was inappropriate behavior, which didn't go over too well.  things ended with the patient chasing our manager down the hallway in his wheelchair and calling him a homosexual.  cue the sheriff.

and a few days after that, one of my coworkers was asked to put his patient's coat away.  he opened the closet in the room only to find a samurai sword.  yes, a samurai sword.  when the sheriff showed up (for the fourth time in two weeks, but who's counting?), the patient was also found to have a hoard of oxycodone and his urine came back positive for cocaine.

these things happen in the land of trauma drama, but not usually so frequently and never so publicly.  but now here we are, on display for the rest of the hospital to see.  i'm half glad that other nurses can see what we're dealing with while they're taking care of normal looking people, and half embarrassed to be "that floor".

thankfully it will only be a few months until we move back to our own unit, tucked away in a corner by ourselves for reasons that i now see very clearly.  and it's my hope that these few weeks of lawlessness will reinforce to 'the man' that we really do need the locked unit we've been begging for.

but until then, new neighbors, my apologies.

presence

nursing is usually just a series of tasks.  pass the meds, walk people, do some dressing changes, call the doctor to clarify orders, whatever.  we run from patient to patient usually desperately behind and looking to spend as little time as possible in each place so we can catch back up.  the whole idea of patient care, the actual caring about and spending time with people often gets lost in the shuffle.  it's just the way things usually go.

last week i found myself in a unique situation.  we were shuffling all of our patients from one unit to another because of construction.  my job was to wait for my patients on the new unit and to settle them as they arrived.  because of the hugeness of picking up and moving a whole unit in several hours, we were blissfully staffed with the never before (and never again, i'm sure) ratio that essentially left all of us with only 1 or 2 patients to move.  my first "patient" to arrive was actually just her husband pushing a wheelchair of her belongings, as she was in the OR.  the patient had advanced cancer and was getting a washout for an infection from a previous procedure.  as i started to put her things away, the surgeon came to the room to let her husband know her surgery was over.  i was on my hands and knees wiping up the entire bottle of the saline i'd just dropped on the floor when i heard him tell the husband that there was a tear in the bowel.  this was followed by a very matter of fact "if she gets a fistula, i think it's time to pursue palliative care.  if it were my wife i'd start thinking about how long you want to fight this thing".  and then the surgeon left, and it was just me and my patient's husband whom i had met less than 5 minutes before.  

what do you say in a moment like that?  i've been there?  i'm sorry?  i'll do whatever i can to make this even the tiniest bit easier for you?  all of the above?  are there really any words that can blunt the pain of that kind of conversation?  

no, there aren't. 

in nursing school we aren't taught how to be helpful when someone's world is falling apart, probably because that's not something that can be learned.  so i offered the husband what i had, what i NEVER have but for some reason on this day in this situation, i did.  my time.  no other patients to worry about, no other tasks to run to, no ringing phone to interrupt the moment.  

i sat with him.  i gave him the comforting words that came to mind, and when those sounded like not enough to my ears i was just there.  it didn't change things, or make the truth any less difficult, but it was something.

i think that it's easy to lose sight of the fact that just being present when people are hurting is helpful.  sitting with someone whose heart is breaking is sad and sometimes uncomfortable, and for me brought up memories that i'd rather not remember.  but it was what the moment called for, and because of that i was happy to be there.  

this is the thing that i so easily forget: taking care of people means actually caring.  it's so easy for me to view the day as a giant checklist of meds and tasks that i put a line through when i finally finish.  i power through 10 or 12 hours with a death-grip on 'my plan for the day', trying to be productive and efficient.  but sometimes the day just calls for sitting in a chair and shedding a few tears for someone else's pain; for offering up my presence when i have nothing else to give.

2014

2013, i don't know what to say about you.  it wasn't a bad year, but it certainly had it's moments.  it was a year of growing pains, and i'm not quite sure why.  i feel like this was the year that i became officially branded as 'trouble' and i resent that.  i feel that the hospital's need to make money, cut costs, please patients to unrealistic levels, and essentially eat the lower half of the state reached an all time high.  i feel that i'm being asked to do more things in less time taking care of higher acuity patients and all with a smile on my face.

but that, i suppose, is just healthcare now.

in 2013 i finally learned to stay in my own backyard; that i need to leave people to care for their patients in their own way and that i get to do the same.  i don't find myself having as many run-ins with the residents, mostly because i don't really think that i have anything to prove anymore.  i know that i'm good enough, and i think i'm figuring out more and more which battles to fight for my patients and which to just let lie.  the longer i work at this job, the more that i see the shades of grey: the policies that don't apply in every situation, the rules that can be bent, the nontraditional ways to provide good care...just a more intuitive way of practicing.

i'm not a perfect nurse, not by a long shot.  but i care about my patients, i want to give them my best and that is something.

so without further ado, in 2014 i would like to:

• be less judgemental; of the doctors, of my patients, of my coworkers.  we are all only human and doing the best we can.  i need and expect grace when i fall short and i need to give it in return as well.
• try to be manageable.  i have a rebel's heart, and i don't like being told what to do/how to do it.  as a result, i have a big problem with authority.  i realize that i'm to the point where i've got an axe to grind over just about everything that comes out of 'the man's' mouth.  i need to be open to trying things a different way, and i need to give change a chance.  
• not let 'comfortable' become 'stuck'.  my job is like a little security blanket that i haul with me wherever i go.  i know it,  i'm good at it, and i'm more than a little afraid that i'll turn around one day and realize that i'm about to retire and i never left the floor because it was easier that way.  i simultaneously want to be challenged and am terrified of the unknown.  i need to keep my eye on the prize, which right now seems to be moving to the ICU.
• never be too busy to be compassionate.  i easily turn selfish and focused on my own stuff, and it freaks me out how i forget to be grateful that i'm not the person in the bed.  cardiac nurse bff once told me about a patient satisfaction survey where someone complained 'no one said sorry i'm sick'.  entitled as that might be, it stuck with me, and now i try to remember to tell my patients that i'm sorry this happened to them.  

i like the new year because i like definition and order and the belief that one particular day turning into the next somehow means that i have a clean slate.  i guess that's what i want more than anything in 2014.  i need a fresh start, and the chance to prove that i can be better than i am now.  first i was a good person, then i was a good nurse, and now i want to be both.  

here we go.