Nurse Ratched’s Place

Psychiatric nurses get to meet many famous people throughout our careers, well sort of. Sometimes we care for patients suffering from delusions of grandeur. When I was a student at a Veterans Administration hospital, I cared for many “A List” celebrities. I met President Harry S. Truman, the Virgin Mary, and Albert Einstein. I also had the honor of meeting three gentlemen on a unit, all claiming to be Jesus Christ. The unit nurses dubbed the trio “The Jesus Three.”

The Jesus Three were a happy trio that spent a lot of time together in the unit’s sunroom, reading the Bible and debating religion. They also walked through the unit baptizing other patients and the staff. I felt a gentle mist of water landing on the back of my neck one day as I was talking to one of my patients in the dayroom. I turned around and found one of the men with a plastic spray bottle. He smiled as he baptized me and said he was saving my soul. I thanked him, and went on with my conversation.

I couldn’t understand how these gentle souls ended up in the hospital. They never yelled or cursed, and they helped out the nursing staff by feeding patients who couldn’t feed themselves. I also saw them writing letters for those who couldn’t read or write, and chatting with patients who never received any visitors. I found out later that their family members didn’t want to deal with “peculiarities,” so they had them committed into the hospital. That sort of thing was commonplace back then, and unfortunately they got swept up in an unfair system.

Nurses are taught never to feed into a patient’s delusions, but on the last day of my psychiatric clinical rotation, I just had to ask them how they could all be Jesus Christ. After all, didn’t the Bible say that there was only one true Messiah? They all looked at me and smiled. One of the men said, “I guess that just proves that the spirit is among us.”

Maybe angels really do walk among us on psychiatric units.

I’m getting word that the name of my blog is upsetting some people, so it’s time that we clear the air and discuss some issues that are circulating within the nursing community.

There are nurses in our profession who are on a mission to elevate the profession of nursing by combating nursing stereotypes. They truly feel that as long as nurses are portrayed as buxom sex-craved women, or women such as Nurse Ratched, the profession will forever be condemned to subservience. I applaud anyone who stands up and fights for their beliefs, however I think that nurses are missing an important point.

Despite prolific stereotypes of nursing within our culture, nurses are the most trusted professionals in America. The public loves us and no one in their right mind believes that these stereotypes are an accurate portrayal of our profession. We are viewed as angels of mercy, another stereotype that many nurses are willing to accept. The problem with nursing isn’t how we are portrayed in pop culture, or how the public views us, the problem is entrenched in how nurses view each other. Nursing is not only a profession; it’s a culture all to its own, and frankly, it’s the most catty and backbiting culture on the planet. I’ve never been able to explain this phenomenon, but I’ve always suspected that it’s because the nursing profession is swimming in estrogen. Yes, my statement could be construed as another stereotype, but come on, let’s be honest, I bet that thought has crossed your mind, too.

Cultural stereotypes aren’t the problem; we are our own worst enemy. We can’t even agree about who is qualified to be a nurse. The great debate about who is educationally qualified to be a nurse rages on. Outsiders with a bird’s eye view of our profession can’t figure us out, or they take advantage of our divisions, and use them to exploit us. For example, hospital administrators have exploited these divisions for years, and continue to use them to subjugate their nursing staff. Other professions, such as doctors, are also stereotyped in the media, yet they are thriving as a profession. Doctors are powerful within hospitals because they don’t undermine their colleagues, and they work together as a united front. Nurses need to take note, and follow the example set by physicians.

Believe me, when Ken Kesey wrote One Flew Over the Cuckoos Nest, he wasn’t thinking, “Gee, how can I insult nurses. I know, I’ll create Nurse Ratched. That will do the trick.” Nurse Ratched is a literary metaphor for a lot of different things, and I make no apologies for choosing Nurse Ratched’s Place for the name of my blog. As an ardent bibliophile, and as a psychiatric nurse, I find her character fascinating and I enjoyed the book. Stop throwing rotten tomatoes, and start focusing on making relevant changes that will empower nurses.

Let the hate mail begin………..

I know that some of you think that the old-fashioned capping ceremony is corny, but I feel bad that some of you have never gotten to experience the thrill of getting your cap or pin, so I wanted to share this picture with you. Yep, that’s me many moons ago. How do I look? Of course, other than the gray hair, the extra pounds, the wrinkles, and the sagging body parts , I look the same today as I did on the night that I received my cap. Hey, don’t challenge my delusional system unless you can replace it with something better. I wonder what score Kim from Emergiblog would give my cap based on the Emergiblog Cap Rating Scale. By the way, did you know that we used Lubrafax to glue our stripes onto our caps?

I received this email from my mother and I wanted to pass it on to you. It’s cute. Don’t write these entries at work:

Charting Bloopers
(Actual writings from hospital charts):

1. The patient refused a autopsy.

2. The patient has no previous history of suicides.

3. Patient has left white blood cells at another hospital.

4. She has no rigors or shaking chills, but her husband states she was very
hot in bed last night.

5. Patient has chest pain if she lies on her left side for over a year.

6. On the second day the knee was better, and on the third day it disappeared.

7. The patient is tearful and crying constantly. She also appears to be
depressed.

8. The patient has been depressed since she began seeing me in 1993.

9. Discharge status: Alive but without permission.

10. Healthy appearing decrepit 69-year old male, mentally alert but forgetful.

11. Patient had waffles for breakfast and anorexia for lunch.

12. She is numb from her toes down.

13. While in ER, she was examined, x-rated and sent home.

14. The skin was moist and dry.

15. Occasional, constant infrequent headaches.

16. Patient was alert and unresponsive.

17. Rectal examination revealed a normal size thyroid.

18. She stated that she had been constipated for most of her life, until
she got a divorce.

19. I saw your patient today, who is still under our car for physical therapy.

20. Both breasts are equal and reactive to light and accommodation.

21. Examination of genitalia reveals that he is circus sized.

22. The lab test indicated abnormal lover function.

23. Skin: somewhat pale but present.

24. The pelvic exam will be done later on the floor

25. Patient has two teenage children, but no other abnormalities

I saw this on eBay last week. Isn’t it cute? I remember my capping ceremony. I stood in front of a crowded church while reciting the Florence Nightingale Pledge. It’s something that I will never forget. Looking back, I’m amazed that I ever got to take that pledge, or that I made it through nursing school.

I went to nursing school in a small town in Southern Illinois. Racial tensions were high, and the Klu Klux Klan was in its glory. The schoolwork was hard enough, but imagine trying to get through your emergency room rotation as one of your teachers is bragging to the other faculty members about how she was going to crucify a Jew. I’ll give you one guess who she was talking about. This woman screamed at me in front of my classmates, and in her office behind close doors. She constantly told me that she would made sure that I never made it through nursing school. I quietly took her abuse. I was young, inexperienced, and scared, but I was determined to stick it out. I decided that I wasn’t going to give my teacher the satisfaction of running me out of town.

Those events happened many years ago and I’m still standing. I am bulletproof and unbreakable. I am a real nurse.

Iris from “Did I Just Say That Out Loud ????” has started a meme which asks what makes someone a real nurse. I’ve posted my answers, and I hereby tag Kim at Emergiblog, Deacon Barry, Nurse William, and anyone else who wants to play.

Real nurses can talk about all kinds of gross body fluids while eating a meal.

Real nurses can tell a doctor what orders they need to write in a patient’s chart while making the doctor believe that it was their idea to write those orders in the first place.

Real nurses can run a three-minute mile while they are at work in two minutes flat.

When real nurses get together, they grip about work. Sorry, but if you think that today’s hospitals are focusing on how to provide good quality care, you aren’t a seasoned nurse, and you are naive. Hospitals are running their nurses into the ground and real nurses know that hospitals are strictly profit driven.

Real nurses are patient advocates.

Tag, you’re it!

I found a letter in my post office box late last week from our hospital administrator, Mr. Grinch, announcing hospital pep rally week. He said he loves working with us, and that we will be celebrating excellence. Mr. Grinch explained that our wonderful hospital has five “Pillars of Excellence” that guide our daily actions and decision-making policies. The pillars are Quality, Service, People, Innovation, and Finance. I immediately thought that I had found a typo in the letter when I discovered that Finance was mentioned as the last pillar. After all, nurses are constantly being told that we have to work harder with less staff in order for the hospital to make more money. Mr. Grinch said that he was was very excited about the upcoming events. Here’s what’s happening this week at the hospital:

Monday: Silly Hat Day.

Free Hot Breakfast Bar in the hospital cafeteria from 6-9 a.m. Employees must be wearing a silly hat to get a free breakfast. I’ve heard of singing for your supper, but I’ve never heard of looking silly for your breakfast. I think I’ll pass.

Tuesday: Crazy Socks Day.

Sorry, there are no prizes for wearing crazy socks on Tuesday. You just get the honor of looking peculiar while you are at work.

Wednesday: Wear a Smile Day

Employees who smile are eligible to receive a free chair massage and blood pressure screening in the basement by the cafeteria. Keep on smiling!

Thursday: Hospital Spirit Day

Employees are encouraged to wear hospital colors to work to show their “team spirit.” For doing this, hospital employees will be rewarded with a hamburger or hotdog cooked out on a grill, and a chance to win a FREE flat screen TV. I can’t imagine Mr. Grinch giving away a nice television. Maybe he plans to charge a delivery fee equivalent to the cost of the television. I wonder if it’s the same kind of TV that Mr. Grinch has in his luxurious office.

Friday: Jeans Day

Once again, there are no special prizes for wearing jeans to work, but the hospital plans to deliver special gifts to each department. Maybe I’ll drop by the hospital to see if these guys are our “special gifts.”

I felt butterflies in my stomach after reading my letter from Mr. Grinch, or maybe it was just gas. Oh yeah, I’m feeling the love. Anyway, I can’t wait to see what they come up for us for Nurses Week. I heard that the hospital plans to spend 4 bucks on each nurse. Well placed sources have told me that Mr. Grinch plans to buy us each a flash light. Oh joy, now I’m really feeling the love. I’ll keep you posted.

You can find them in every town, living somewhere on the wrong side of the tracks. They are doctors and nurses, looking for a few cheap thrills. Dedicated professionals by day, these harlots and lustful men meet in dark corridors of seedy hospitals, full of passion, longing for each other’s touch. Their steaming hot bodies yearn for excitement, but in the end, they find only momentary pleasure. Their flesh is weak and their souls perish in the flames of their desires. Once again it is time to visit the men and women of medical pulp fiction.

I love the covers on these sleazy books, don’t you? My book collection is growing, and I’ve found these books on the Internet. Here’s a sampling of my new acquisitions.

She was his nurse and his office wife! That’s why Janice and Eric simply had to keep their love for each other a secret. But how long could such a secret be kept from Eric’s lovely, ruthless wife, Elissa—or from Ben Archer, the man who was determined to marry Janice?

How long could Janice and Eric go on seeing each other every day, tortured by the few moments of intimacy they were able to steal? All that was bottled up had to rise to the surface and break through like a volcano erupting…it had to happen!

This is just another illustration of why NOT to have an affair at work. Things don’t get done, and people are going to find out about your relationship. And I’d like to know what the job description is for an office wife. I’m sure it has nothing to do with cooking or washing windows. I think Nurse Janice is about to get her hair torn out by a pissed off wife.

What do rules mean to a girl torn by passionate yearning? Yet Joy Durling, nurse and woman, found herself trapped by two sets of rigid, moral codes—those which forbid a nurse to get emotionally involved with her patients, and those which damn a woman who loves another woman’s husband. Joy found that working beside a young doctor, watching his strong hands move over the patient, feeling his strength, his will, change the lives of helpless men and women, was an experience she could not ignore. Despite her struggle to avoid it, Nurse Durling found herself swept into a love-torn situation with her patient, her patient’s ruthless husband, and with handsome Dr. Barry Kirk….a turbulent foursome that almost led to the ruin of all of them.

What is it about being an office nurse that makes a girl’s libido go haywire? Nurse Durling sounds like she has very poor personal boundaries. She needs to snap out of it and start taking better care of her patients. The woman is the background needs some privacy while she is getting dressed. And Dr. Kirk better watch out. Nurse Durling might change her mind about him and charge him with sexual harassment in the workplace. Good grief!

Being a nurse, and a sensationally attractive woman besides, young Laura Weston found it ridiculously easy to make a conquest of R. Steven Prescott. From the first moment of intimacy in her apartment, he found himself slipping deeper and deeper into her power—at last becoming her helpless tool in a racket which had become one of the obnoxious social evils of our times.

Working outside the law, Laura executed her black plans with the boldness and precision of a master villainess, relying not only on her wits, but also on her superb body. Could nothing stop this beautiful, unscrupulous woman?

Poor Dr. Prescott. Laura used her pretty face to sucker him into working for a black market baby-selling ring, and now Dr. Prescott wants out of the deal. Laura is a tricky office nurse, and it looks like her boss has had it with her shenanigans. Now I’ll admit, I’ve done some things in the past that have really gotten some doctors upset with me, but I never remember doing anything that made them want to kill me. Wait, maybe once, but that’s another story. It looks like Dr. Prescott is about to air his grievances with Nurse Weston. Maybe he should start out by discussing the office dress code.

There is nothing worse than bitchy eggs. Enjoy your Easter weekend!

What’s going on here? This looks vaguely familiar. Wait a minute, I remember, it’s called patient teaching. This is a visiting nurse teaching a new mother how to make formula for her baby. I know this is going to come as shock to many younger nurses, but we use to have lots of time to do patient teaching. Nurses would spend hours doing 1:1 teaching at a patient’s bedside, but those days are gone. Now we barely have enough time to learn our patients’ name before their HMO pushes them out the door.

My first job as a psychiatric nurse was a dream come true. I had time to really talk to the patients, and to listen to what they had to say. Each staff member created a group based on our own area of personal expertise. I am the queen of bargain hunting, and since many of my patients lived on a fixed income, I created a “shopping group,” in which I taught patients how to create a budget and shop for the best deals. During the winter months, my patients and I clipped coupons, and we studied the local newspaper and penny saver paper looking for good deals. When the weather was nice, the occupational therapist and I would take the hospital van and drive patients to yard sales, flea markets, and thrift stores as a way of teaching them how to stretch a dollar. We had the patients make up a shopping list, and then we would give them money to buy their items. Today’s HMO companies would never reimburse a hospital for that group. HMO won’t let us take patients out anymore because “if they are well enough to go outside of the hospital for a group, they are well enough to go home.”

Since hospitals are demanding that nurses do more work with less staff, I’ve created this group that takes into account the time constraints placed on busy nurse’s schedule. I estimate that a nurse can complete this 1,2,3, Zing group in about 15 minutes. Maybe the insurance companies will pay for it if we document the activity as a socialization or nutrition group. Things go better with Coke.

It’s hard being the perfect woman, the perfect mother, and most importantly, the perfect nurse. I need to re-read this book and take a refresher course on how to be flawless because I screwed up at work.

I went to bed last night after working my usual Sunday evening shift and I went right to sleep. I was exhausted when I arrived back home, and I was well on my way to falling into a deep, peaceful sleep when I woke up around 2 A.M. I sat straight up in bed and screamed a succession of naughty words when I remembered that I hadn’t documented that my patients had received their 10 PM meds. Now I promise you, my patients got their medications, and I know that I can document those medications when I return to work, but crap, I hate it when I make mistakes. I’m the charge nurse, I’m the old pro, I’m suppose to be perfect! I tossed and turned in bed, and I couldn’t go back to sleep. Some people would say that I had a senior moment, while others might suggest that I had a mind fart, but whatever you call this phenomenon, it SUCKS.

Hospitals require perfection from their nurses, and God help you if you fail to meet their employer’s expectations. Perhaps Fujitsu’s new service robot will replace me if I make any more mistakes at work. I guess my boss will have something else to throw in my face during my next evaluation.

This is my favorite Rolling Stone magazine cover. Yes, I enjoy reading Rolling Stone magazine. I may have gray hair and wrinkles, but I’m a hip old broad.

I’m sure that some of you hate Howard Dean, the originator of the “Dean Scream,” and the current chairman of the Democratic National Committee, but before you start throwing tomatoes at me, let me tell you why I’m so fond of this cover. Ready? There’s a DOCTOR on the cover of this magazine! Now that’s newsworthy. Go Howard!

Did you know that there are doctors and nurses serving in Congress? My favorite doctor currently serving in the House of Representatives is Jim McDermott, a psychiatrist from Washington. I think we need more psychiatrists working on the Hill, but I digress. Representative McDermott re-introduced a bill last month that would improve access to health care. He said, “Access to affordable health care coverage is the single biggest domestic crisis facing America today. The health care crisis gets worse every day and, because of it, more Americans get hurt every day.” He is also a cosponsor of a bill that would create the Office of the National Nurse. Thank you, Dr. McDermott.

Another doctor working on the Hill is Senator Tom Coburn, a family practice doctor from Oklahoma. He just introduced a bill that would also improve access to health care. In a recent press release, Dr. Coburn said, “Americans are tired of out of control medical costs, gatekeepers blocking access to the doctors they want to see, being denied coverage of medically necessary care, and health plans that they don’t understand. This bill addresses all of these problems and does so without creating new government programs or bureaucracies. In fact, this bill removes government and insurance bureaucrats from the doctor’s office by providing patients with federal tax rebates that will ensure that every American can purchase the health care coverage that best meets their medical needs.”

Dr. McDermott is a Democrat and Dr. Coburn is a Republican. Doctors from both parties are promoting health care legislation on Capitol Hill. We need more doctors and nurses in Congress.

We also need more doctors on magazine covers.