Nurse Ratched’s Place

It’s been awhile since I posted any email from Mother, and since my bones are aching today, I’ve decided to share a secret that she passed along to me today in her latest email. Maybe we can all be more like grumpy Maxine, and learn to look at the bright side of life.

PERKS OF BEING OVER 50

1. Kidnappers are not very interested in you.

2. In a hostage situation you are likely to be released first.

3. No one expects you to run–anywhere..

4. People call at 9 PM and ask, “Did I wake you?”

5. People no longer view you as a hypochondriac.

6. There is nothing left to learn the hard way.

7. Things you buy now won’t wear out.

8.. You can eat supper at 4 p m.

9. You can live without sex but not your glasses.

10. You get into heated arguments about pension plans.

11. You no longer think of speed limits as a challenge.

12. You quit trying to hold your stomach in no matter who walks into the room.

13. You sing along with elevator music.

14. Your eyes won’t get much worse.

15. Your investment in health insurance is finally beginning to pay off.

16. Your joints are more accurate meteorol ogists than the national weather service.

17. Your secrets are safe with your friends because they can’t remember them either.

18. Your supply of brain cells is finally down to manageable size.

19. You can’t remember who sent you this list .

And you notice these are all in BOLD print for your reading convenience.

I’ve always thought that the Beatles wrote this song about nurses. We work like dogs to get our money to buy our things, and we sleep like logs after a long grueling shift. Yeah, yeah, yeah. This weekend seemed like an endless hard day’s night because we had not one, but three patients on our unit with borderline personality disorder. One patient with a personality disorder is bad enough to handle when you are under staffed, but three patients make a trifecta for a miserable weekend.

Borderlines love to compete with each other, and there is no limit to the mischief they can get into when they aren’t the center of attention. All of my little lovelies were racing to see who could cut themselves the deepest by using their plastic dinnerware. Here’s a picture that gives you an idea of what their arms look like. Yeah, it’s gross. Back in the good old days when we were allowed to use some extreme behavior modification techniques, nurses would never feed in to this type of self-destructive behavior. We would ignore the behavior, give the patients a bandage so they could dress their own wounds, and life went on as usual. No one made a fuss unless there was blood pumping out of an artery. The patients did not receive secondary gain for engaging in self mutilation. They would figure out pretty quickly that their activities weren’t going to ruffle our feathers, so their self-destructive behaviors would stop.

Now, it’s a whole new ballgame on psychiatric units, and the borderline patients know the rules. Patients are now placed on suicide watch if they so much as scratch themselves while they are in the hospital. Borderlines crave attention, and their behavior escalates as they receive more attention for their inappropriate behavior. What really burns my butt is that nurses are getting into trouble if these patients shed one drop of blood while they are in the hospital. That’s why Border Nurse is leaving the country. She’s had it! Her decision has nothing to do with the guy in the brown suit. Doctor Dream Boat is out of luck because the object of his affection is tired of being held responsible for all the crap that happens on her unit. Patients are rewarded for acting out while their nurses get the boot.

I just received a phone call from work while I was writing this post. My boss asked me to come back into work. Fat chance! I’m going to sleep like a log for a few more hours. Good night!

Fellow nurse blogger, Tammy Swofford, asked me to write a little something about Thanksgiving. She wants to know what people are thankful for, so here it goes:

I’m thankful for a messy house. Living with dust bunnies under a solid roof means that I’m not living out on the street. I’m thankful for a husband that gets underfoot when I’m trying to clean the house. That means that he loves me, and that he would rather be home with me than anywhere else in the entire world. I’m thankful for daughters who drive me crazy. They live away from home, but they still love and trust me enough to tell me all the intimate details of their young lives. That’s the part that drives me crazy. There are some things that a mother doesn’t want to know. I am truly thankful for the many annoyances in my life.

I’m also thankful for dirty dishes. My grandmother cut this poem out of a Kitchen Klatter Magazine when I was a little girl, and taped it on the wall by the kitchen sink. This is what she would read to me while we were washing the dishes.

Thank God For Dirty Dishes (author unknown)

Thank God for dirty dishes, they have a tale to tell,
While others are going hungry, we’re eating very well.
Home, health, and happiness, I shouldn’t want to fuss,
With the stack of evidence, God is good to us.

Happy Thanksgiving!

I love Christmas stories with happy endings, but alas, this story ends with a lump of coal in everyone’s Christmas stocking. Last year at about this time I told you all about the generosity of our hospital administrator, Mr. Grinch. He sent the hospital employees a letter last year, and this is what it said:

“Dear Valued Employees:

In the spirit of the holidays, the administrative staff of the most wonderful hospital in the world sends you Christmas greetings. And oh yes, by the way, since we’re not making a lot of money this year, you’re not getting your gift card and we are canceling the holiday party. It’s too expensive to show you how much we appreciate all of your hard work. And since we know that our employees have big hearts, we are offering payroll deduction so you can contribute your hard earned money to pay for gift cards that will be given to the 120 employees that we pay the least throughout the year. Have a Happy New Year!”

History is repeating itself. This is what Mr. Grinch wrote in this year’s Christmas card.

Dear Valued Employees (notice how the guy still hasn’t learned our names):

This has been an exciting year at the Most Wonderful Hospital in the World. We have a brand-spanking new emergency room, and wide screen TVs in all of the patients’ rooms. Patients also have access to wireless Internet services from their rooms, and we have installed an expensive water fountain in our newly created serenity garden that you can go stare at when you are all stressed out. And let’s not forget about that new gourmet coffee bar we have in our new Hilton-styled front lobby. Yes sir, we rock! Unfortunately, all of those improvements have been very costly, and they didn’t entice new patients into coming to our hospital, so that means that you are not getting a Christmas bonus from the hospital this year. However, we encourage you to donate to a fund that we have created that will benefit our poorest employees. You may write a check, or you may donate to the fund through payroll deduction. See, we really do have a heart.

May God bless you and your family during this holiday season.

I went to work the next day after receiving the good news about our Christmas bonus, and I noticed that I was not the only employee who was upset by Mr. Grinch’s letter. I walked down to the new garden in search of serenity, and I noticed crumbled copies of the letter floating in Mr. Grinch’s new expensive water fountain.

Merry Christmas to you, too, Mr. Grinch.

Excuse me nurse, but did you forget to do something this morning before you came into work? At least she remembered to put on her cap. Our pretty nurse isn’t making a fashion statement, she just didn’t get enough sleep last night. If you look closely, you will see that she is walking around in a daze. She can’t focus on the thermometer that she’s holding, and she looks like she wants to take a nap. Thank goodness she doesn’t have to iron her underwear. That way she can catch a couple of more minutes of sleep.

There are a lot of reasons why nurses don’t get enough sleep, but I think one of the biggest reasons is related to shift work. I once worked at a hospital that constantly made nurses work day, evening, and night shift all within a two-week rotation. None of us knew if we were coming or going, and there wasn’t enough caffeine on the planet that could keep us awake. Then we went home and we couldn’t sleep. I became very sick and I quit my job for the sake of my health. Reasonable people understand that making nurses work like this isn’t good for anyone, but many hospitals still expect nurses to work swing shifts. One of my good friends gave his boss a note from his doctor explaining why he couldn’t work swing shifts. My friend developed a sleeping disorder and started suffering from terrible headaches, so he wanted to work a steady shift. He thought his boss would understand, but instead of receiving support from his boss, he received a bunch of crap. His boss didn’t believe him. She accused him of lying to his doctor in order to obtain his “bogus note,” and she drilled him about his medical condition. She also demanded that he sign a release of information form so she could personally review his medical records. I won’t tell you what he said in response. Just use your imagination. Things aren’t going to get any better until nurses refuse to take abuse.

It doesn’t look like our lingerie nurse shops at Victoria’s Secret. Maybe she can get some fashion tips from an angel after she gets some sleep.

Road Trip! Doctor Anonymous is hosting Grand Rounds this week from Tucson, Arizona. He won’t tell me exactly where he is, but I think he is in the room with the cactus by the front door. Why would he have a cactus by his door? Go to Grand Rounds and find out. (Here’s a hint: He apparently likes hanging out with plants.)

I know what you’re thinking. You think that this nurse is clueless, and that she is about to be attacked. But do you see the smile on her face and the twinkle in her eye? Mr. Criminal doesn’t know it yet, but all hell is about to break loose. Security officers are about to storm the unit, and Mr. Criminal is going into four point leather restraints.

Nurses may be angels of mercy, but we have no problem setting aside our halo and wings when we are being attacked. Believe me, the kid gloves come off when someone tries hitting a nurse. Psychiatric nurses are pros at kicking some serious butt, and we have no problem with giving copious amounts of Haldol to a violent patient while we are putting them into restraints. Personally, I will do whatever it takes to de-escalate a situation before it spins out of control. I’ll spend lots of time talking to patients, and I try to understand what they need to help them regain control of their behavior. I do this for many different reasons. First and foremost is the issue of safety. Takedowns are extremely dangerous for everyone involved. I’m too old to rumble, and I don’t want my patients to get hurt. There are times, however, when some people come into the hospital looking for a fight. Some of these patients have criminal backgrounds, and they utter the word “suicide” so they aren’t hauled off to jail. There is nothing that can stop them from acting out, and nurses are forced to respond. If you ever see a nurse smiling while a patient is threatening to harm them, please stand back.

The best is yet to come.

I love wearing Nikes. They feel good on my feet, and they help me run faster when one of my patients is going berserk. Now we all have another reason for loving Nike shoes. Nike has linked up with six kids at Doernbecher Children’s Hospital in Portland, Oregon to design their own unique shoe lines which will be sold at Niketown stores around the nation and on niketown.com. The kids – who have medical conditions ranging from kidney disease and brain tumors to arm reattachment and open heart surgery – have pretty amazing stories. My favorite story is about Alice Heinz. She is 14 years old and she designed a pair of shoes based on her mom’s nursing uniform because her mom has a hard time finding shoes to match her scrubs. Heinz’s blue and green Air Dunks have numerous details including the words “Live, Love and Laugh” on the shoes’ cup soles.

Proceeds from the sale of the new line of funky-styled shoes go directly back to the children’s hospital to fund research and provide care for uninsured kids. The program has raised $850k for the hospital since the first line of shoes went on sale three years ago. I think the whole idea is really cool.

Go Nike!

Some things never change. Pain and suffering are unacceptable reasons for not going to work. This ad is from 1948, and our pretty factory nurse is saying that tooth pain isn’t going to keep anyone from doing their job at the plant. God forbid that dental pain interferes with production! She, of course, would never consider missing work because she is a nurse. Even if she’s dying, she will crawl in on her hands and knees, and report for duty. Nurses are odd people when it comes to taking care of our own health. We will make sacrifices and do whatever is needed in order to care for our patients, but we won’t take care of ourselves.

The health care system is like a factory, and nurses are cogs in the machine. Nurses are taught that the machine will breakdown if they don’t report for their shift. Most nurses feel guilty if they are unable to come to work. They know that their coworkers are going to have to work harder because they are short of staff. I’ve worked with nurses who have worked their entire shift with a fever, or while they were suffering from a gallbladder attack. And the situation really gets tough when nurses start having children. Many years ago nurses were expected to work right up until the stork arrived. I knew a nurse who went into labor at work, and the nursing supervisor asked her if she could pick up an extra shift as she was being taken into the delivery room. I, too, waddled up and down the halls of a medical-surgical unit when I was pregnant with my first child. One night I thought I was going into labor while I was at work. I was checking a patient’s IV when I doubled over in pain and nearly passed out. I grabbed the side rail of my patient’s bed, and the poor man freaked out. I remember him yelling, “Someone, help! My nurse needs a nurse!” My daughter was born two days later during my day off from work. I lucked out.

A doctor once told me that nurses make the worst patients. He was a very wise man.

Meet Nurse Diane Waycott and Dr. Ken Michelson. They look like a cute and cozy couple, but they have a torrid relationship. In between fighting to save lives, they are frequently fighting with each other.

“You don’t belong in a hospital! If you were honest you’d operate a beauty parlor.” Nurse Diane Waycott flung these bitter words at plastic surgeon Dr. Ken Michelson the night her mother died. Maddened with grief, she believed that her fiancé was more concerned with preserving vanity than saving life. But when a young girl, victim of an auto crash, was brought to Emergency with a bloody, unrecognizable face, Diane knew that only Ken could help.

Telling a doctor to quit medicine and open up a beauty parlor is hitting below the belt. I wonder what the good doctor did that pissed off his girlfriend. There is one positive side to fighting with your mate. It’s the kissing and making up part that’s really fun. Medical romance novels have been around for years and Dr. Brendan Kelly, a psychiatrist living in Ireland, has conducted a tongue-in-cheek study of my favorite literary genre.

Dr. Kelly looked at 20 medical romance novels selected at random and reported a “marked preponderance of brilliant, tall, muscular, male doctors with chiseled features, working in emergency medicine.” And as always, they are having relationships with weak, swooning nurses who would do anything to please their man. I’ve worked with a lot of doctors over the years, and I’ve not met many physicians who had chiseled features, but I have known far too many nurses who are people pleasing doctor- chasers. I went to school during a time when girls entered nursing so they could marry a doctor, but that’s another story.

Dr. Kelly laments that none of the doctors in the novels that he looked at were psychiatrist. I guess that medical romance writers think that psychiatrists are wimpy old men who are too bookish to be sexy, and that they all look like Sigmund Freud. The publishers of the Harlequin medical romance series said that they have a loyal following, and that their books are very popular in France. Maybe I will shift gears and start writing medical romance novels for a living. I can easily pen a book about all of the hot and steaming romances that I’ve seen between doctors and nurses throughout my nursing career.

Or would that be extortion?