The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital by Alexandra Robbins Page B
Authors: Alexandra Robbins
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told me, “If I have a shitty nurse, it affects my entire day.” But it is imperative that the professions acknowledge that every member of the team deserves a voice.
In his 2011 commencement address at Harvard Medical School, surgeon Atul Gawande said, “We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.” He explained to the graduates that the hospitals that achieve the best medical performance results are not the most expensive, but rather, the places where “diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.”
To get there, healthcare organizations are going to have to force stakeholders to agree on the most effective role for a twenty-first-century nurse. As a Canadian ER nurse posted on KevinMD.com , “The issue boils down to whether the healthcare industry can tolerate highly educated, vocal, critically thinking, engaged nurse-collaborators who, in the interest of their patients, will constructively work with—and challenge, if necessary— physicians and established treatment plans. Or does the industry just want robots with limited analytical skills, who blindly and unthinkingly collect vital signs and carry out physician orders? More importantly, which model presents the best opportunity for excellent patient care?”
SAM CITYCENTER HOSPITAL, September
Before Sam’s first night shift, she guzzled a grande nonfat mocha from the hospital’s twenty-four-hour coffee shop. As a morning person, she wasn’t sure how to handle her sleep logistics to remain alert for a 7:00 p.m. to 7:00 a.m. shift. She had awakened at ten that morning, unable to sleep later. She was scheduled to work three night shifts in a row.
Sam arrived early, wiped down her glasses, tied her long hair back in its usual ponytail, then went to the outgoing day-shift nurse for report. She had heard that the beginning of night shifts were the craziest part of the twelve-hour period. She expected to have several patients initially, and then taper down to two or three. She didn’t expect the outgoing nurse to list six patients immediately, more than a full load. Sam rushed around the department, taking each patient’s vitals. Her ER cell phone buzzed. “Your drip is here,” the secretary said.
“What drip?” Sam asked.
When she got to the nurses station, she looked at the patient’s name on the bag of Cardizem, a heart and blood pressure medication that the pharmacy had premixed. It was unfamiliar. She looked at the computer, and there he was, a seventh patient—and the sickest one—whom the other nurse had forgotten to mention. Sam rushed to the room. The patient, who had come into the ER with an irregular heart rhythm, was in danger of a blood clot traveling to his lungs or brain. Sam hung the drip and prepared the patient for the Cardiac Care Unit, where he would be monitored closely.
By 2:00 a.m., the ER was quieter, but Sam felt like she was going to keel over. She was distracted from her vaguely unsettled stomach only by the piercing headache behind her gray eyes. All she wanted to do was lie down on a stretcher to nap. As she slugged down the hallway, her eyelids drooping, the charge nurse called out to her. “You just gotta keep moving, sweetheart, you just gotta keep moving.” Sam revisited the coffee shop and drank another mocha.
Still, she did not regret her decision to work nights. During the following weeks, she learned that the night staff was more laid back, less harried. By day, the ER was loud; it was hard for Sam to hear herself think. At night, under the fluorescent glow of emptier hallways, it was more peaceful. Only the people who truly needed to be at the hospital were present at night. If a chief resident came down to the ER during the day, he would be accompanied by a fellow and four medical students. At night, the resident visited the patients alone. The ER
In his 2011 commencement address at Harvard Medical School, surgeon Atul Gawande said, “We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.” He explained to the graduates that the hospitals that achieve the best medical performance results are not the most expensive, but rather, the places where “diverse people actually work together to direct their specialized capabilities toward common goals for patients. They are coordinated by design. They are pit crews.”
To get there, healthcare organizations are going to have to force stakeholders to agree on the most effective role for a twenty-first-century nurse. As a Canadian ER nurse posted on KevinMD.com , “The issue boils down to whether the healthcare industry can tolerate highly educated, vocal, critically thinking, engaged nurse-collaborators who, in the interest of their patients, will constructively work with—and challenge, if necessary— physicians and established treatment plans. Or does the industry just want robots with limited analytical skills, who blindly and unthinkingly collect vital signs and carry out physician orders? More importantly, which model presents the best opportunity for excellent patient care?”
SAM CITYCENTER HOSPITAL, September
Before Sam’s first night shift, she guzzled a grande nonfat mocha from the hospital’s twenty-four-hour coffee shop. As a morning person, she wasn’t sure how to handle her sleep logistics to remain alert for a 7:00 p.m. to 7:00 a.m. shift. She had awakened at ten that morning, unable to sleep later. She was scheduled to work three night shifts in a row.
Sam arrived early, wiped down her glasses, tied her long hair back in its usual ponytail, then went to the outgoing day-shift nurse for report. She had heard that the beginning of night shifts were the craziest part of the twelve-hour period. She expected to have several patients initially, and then taper down to two or three. She didn’t expect the outgoing nurse to list six patients immediately, more than a full load. Sam rushed around the department, taking each patient’s vitals. Her ER cell phone buzzed. “Your drip is here,” the secretary said.
“What drip?” Sam asked.
When she got to the nurses station, she looked at the patient’s name on the bag of Cardizem, a heart and blood pressure medication that the pharmacy had premixed. It was unfamiliar. She looked at the computer, and there he was, a seventh patient—and the sickest one—whom the other nurse had forgotten to mention. Sam rushed to the room. The patient, who had come into the ER with an irregular heart rhythm, was in danger of a blood clot traveling to his lungs or brain. Sam hung the drip and prepared the patient for the Cardiac Care Unit, where he would be monitored closely.
By 2:00 a.m., the ER was quieter, but Sam felt like she was going to keel over. She was distracted from her vaguely unsettled stomach only by the piercing headache behind her gray eyes. All she wanted to do was lie down on a stretcher to nap. As she slugged down the hallway, her eyelids drooping, the charge nurse called out to her. “You just gotta keep moving, sweetheart, you just gotta keep moving.” Sam revisited the coffee shop and drank another mocha.
Still, she did not regret her decision to work nights. During the following weeks, she learned that the night staff was more laid back, less harried. By day, the ER was loud; it was hard for Sam to hear herself think. At night, under the fluorescent glow of emptier hallways, it was more peaceful. Only the people who truly needed to be at the hospital were present at night. If a chief resident came down to the ER during the day, he would be accompanied by a fellow and four medical students. At night, the resident visited the patients alone. The ER
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