Copyrighted care

I’m not sure about you, but the concept of hourly rounding – going in to lay eyes on your patients to make sure they are ok, are they comfortable, do they need anything (including for you to leave them the hell alone) has always been a part of my practice. It’s competent care to know what’s happening with your patients, and for that extra CYA, I chart every 2 hours at minimum that my patient was breathing. I also finish my day with a nursing note with a more detailed description of what has happened on my 8, 12 or 16 hour shift, mundane or not. That way, should anything come back to bite me in the ass, I have a plethora of written word by my own hand, showing whomever is interested the entire aspect of my day.

However, there are administrators and managers who believe that nurses don’t do this type of care. As evidenced by 1 or 2 entires on the daily log, a one-line mention of a 12 hour shift that ‘nothing happened’, or worse: falls, gross incontinence, excruciating pain, missed medications and unresponsive patients. It’s unfortunate that in every profession there are good people and there are bad people, and in light of tightening purse strings and increasing public scrutiny, the load on the backs of nurses must increase in order to satisfy the public.

Enter so called “Hourly Rounding” – the copyrighted concept of scripted, timed appointments kept with each of your patients throughout the day. Down to the words spoken to patients, this administrative concept is set to save the nurses from answering call bells, picking up fallen patients, and satisfying the managers, administrators and guests with the consistent attention and service from your health care provider… ie me.

It all sounds lovely doesn’t it? As an RN on a heavy oncology unit, it should come as a ray of light to ease my work load of running back and forth in my confusion, unable to satisfy the needs of my patients on my own by critically thinking out my day and prioritizing the health & safety of each patient, the most critical first to the ‘stable’ (I say stable with a grain of salt – one minute they’re fine, the next they’re dead!), the tasks to be completed and the care to be given mixed in with appointments, visits, meals and nap times.

Except that I find this forced implementation of an office workers idea of nursing (position, pain, provisions and toileting) to be insulting, humiliating, and degrading not only to someone who has a BSc, but to those who are actually in the trenches day after day critically thinking about how to best care for the 4 or 6 patients in their care.

I’m not saying that the above Ps and 1 T aren’t a part of nursing care – they are. But to copyright that those 4 aspects of my day are now the MAIN focus of my nursing existence is absurd. How can all of nursings knowledge be pushed aside in favor of diaper changes and dispensing pain medications?

It kind of feels like I’m back in nursing school. I can remember one teacher, she was the only one to make me cry every shift but in the end made me and continues to make me a better nurse, break us down to square one to rebuild the critically thinking, organized, highly efficient intelligent practitioners of nursing. One of the many questions that still rings in my head, besides “What would ___________ do” in times of crisis, is “What do YOU want YOUR practice to be?” How do I want to handle this? How am I going to think this through and solve this issue?

Critical thinking is what separates the RN from CNAs, from Orderlys, and what gives our profession its right to be respected. Anyone can take a vital sign, change a diaper, give a medication. But it’s how a nurse thinks that makes her so invaluable. With this Hourly Rounding, with all its useless paperwork, its make-work waste of time, it’s micromanagement by Big Brother who has a dated idea of what nurses do & why we do it? It’s making me feel… well, worthless.

Ok, maybe not worthless. I feel like a nanny. I feel like the patients now have 1:1 care beyond their wildest imaginations. It calls to mind a Simpsons quote, after Homer sneaks into Grandpa’s retirement residence and stays for a number of days. “Marge, when I get old you gotta PROMISE that you’ll put me in a home. It’s like you’re a baby, except you’re old enough to appreciate it!”

Instead of reading the chart to gain an understanding of your history, your home life, and what I can do to help you either get home or to a place of care… I’m chasing after the potatoes you didn’t get with lunch.

Instead of discussing your latest blood results with the MD on call, anticipating a re-draw to check for infection or hidden bleeding… I’m cleaning your room.

Instead of participating in our ‘interprofessional rounds’ where each respected profession gives their opinion about your case in a collaborative attempt to give patient centered care… I’m walking a perfectly capable person to the bathroom, then staying to wipe their bum.

None of these tasks would bother me if sprinkled throughout the day… but every hour? You’ve GOT to be kidding me. Along with the fact that I have significantly more work to do, and no extra resources to aid me in completing these tasks. Just more missed breaks, which in turn solidifies the opinion that I’m disorganized & can’t get my work done, thus needing a step-by-step breakdown of how my day should go.

Which brings me to my long winded point. A nurse is a knowledge worker, not a task monkey. She is a qualified, independent health care practitioner, not a beast of burden with a vitals cart and a diaper. But it’s getting harder and harder to not feel like one, especially with systems like this intruding on my ability to think for myself. At this point, I may as well be an orderly.

“He wasn’t expecting you to be so beautiful.”

I still remember his face.

Specifically, I remember his eyes. Milk chocolate brown through thin framed glasses, looking up from his twin sized hospital bed with rails on all sides, securing (or encasing him, depending on who was looking) a solid grip to his shaky hand.

I remember his hair. Dark brown and tosseled, like he had woken from a bad dream only to realize that it was real. His white undershirt and flannel pants in stark contrast to the white washed room, complete with white linen sheets and towels – his new home for as long as necessary to get his treatment in safely and quickly.

It’s 10 past midnight. I’m on my final mentorship night shift with my motherly preceptor Donna. I have left the sanctuary of our little office where she & I had just finished bickering over what pizza to order to celebrate, and what to sneak a quick 20 min break watching bad TV streaming on the one good computer with sound, to answer the bell of the patient we had picked up at 2330. I had a brief chance to look over the care plan: in for high dose methotrexate, or rituximab, or something that required overnight stays and consistent observation for Non Hodgkins Lymphona, the ‘good’ lymphoma so to speak. I’m in my signature purple scrubs – a boxy cotton blend top with a matching boxy cotton blend bottom, and my mood is joyous as I saunter down the hall to the 2nd last room on the left.

“Hi! My name is Chloe. Donna & I will be your nurses tonight. How can I help you?”

And that’s when I saw his eyes. His beautiful, young, forlorn eyes as he looked up from his bed in response to my greeting. I was taken aback – this guy can’t be more than 30… he looks my age. He’s handsome. He looks shocked.

We lock eyes for what seems like an eternity. I’m acutely aware of my breathing and mentally repeat to myself “don’t bite your lip, don’t bite your lip” as we both wait for the other to make the next move. In those moments past midnight in a dark and cold building I feel his sadness. He looks defeated, dejected, almost embarassed. I don’t think he was expecting me.

Finally he breaks eye contact with me and puts his head down. With barely a whisper above the constant whoosh of the IVF entering his veins, he says simply “I have to go to the bathroom.”

Oh, I think, ok. That’s easy.

I rush to his side to offer my hand to help him up. He grabs the side rail of his bed with all his strength, if somehow to show me that he is still a man. He shakes his head politely to my outstretched hand, and I move it to his IV pole and guide him into his private area. He slowly but surely seats himself, and before I can offer any more assistance, I simply ask “Are you ok?” He nods his head and I shut the door, seeing his head hung once more before leaving his room for good.

I walk slowly back to the office with my heart breaking, fighting back tears as I see Donna and Kailey, our 1:1 partner on our line. Donna peers up and instantly knows somethings wrong – I’ve changed.

“Donna… Can you look after room 21 tonight? I… I don’t think he was expecting me.”

“I understand. He’s 27. He wasn’t expecting you to be so beautiful.”

It turns out that despite our average age of 29, my patient in room 21 had seemingly been lucky and had each RN looking after him, with the exception of me, be our old bitties. Each old enough to be his mother, this 27 year old guy was hidden from the awkwardness of being cared for by girls who, in a better time and more appropriate place, he would be buying drinks and dinner – not seeking assistance with the most simple, basic, and intimate tasks of living.

“It’s not that Donna…”, and it isn’t. I’m 2/2 nights out, haven’t showered due to fatigue, have minimal make up on and my hair in its perpetual bun, I’m hardly a sight for sore eyes. It’s different, “it’s that he’s my age, and I’m helping him to the bathroom. It shouldn’t be like this.”

“I know Chloe,” she says, smiling the way mothers do when they know they are right, “he know’s you’re his nurse, but he wasn’t expecting you to be so beautiful.”

Donna takes care of him for the rest of the night. She assists him back to bed after pulling his pants up with tender loving care, and peeks in on him as a new mother peeks in on her infant. I know that technically I’m not carrying my full load as an RN – 6 patients from 2330-0730 – with the light assistance of my mentor, the entire purpose of the program I was lucky to get into, but I don’t care. I’m not the nurse he needs – not because I’m incompetent or incapable, but because I can’t give him the care he needs without emasculating what’s left of the manhood cancer hasn’t stolen away.

It isn’t the way he wanted to meet me – and it’s never the way I want to meet anyone. Yet meet I do, every day, for 8 or 12 or 16 hours of my life. I meet cancer patients at the worst point of their journey. Young, old, sick, well, dying, living. You’re at your worst and sometimes so am I. Because cancer is an indiscriminate thief – latching on to whatever energy is presented and proliferating until it consumes every hour, minute, and second of your life.

At 0745 I’m in my dads grey SUV, exhausted from my second night readjusting my body to the demands of shift work. But my aching body is no match for the pain in my heart and the spinning in my head. I know this isn’t the last time I’ll care for a young and beautiful patient – it won’t be the last time I cry at work over decisions I’m responsible for fulfilling yet have no authority over – it won’t be the last time I leave miserable with the burden of misbelief that I can make a difference. Yet the simple truth is, I can’t do anything else.

I love being a nurse. Even when it seems like every shift is a nail in a life-long coffin of my choosing.

Bait and Switch

It never ceases to amaze me when my single girl friends get it into their heads that what a guy wants from a girl is an easy, no effort, laid back, casual ‘thing’, and by agreeing to this easy, no effort, laid back, casual ‘thing’ with him will somehow morph him into the perfect boyfriend.

Yes, Hollywood is showing us the new and improved way of attaining the storybook ending of relationship dreams: Friends With Benefits, No Strings Attached, When Harry Met Sally… The post modern idea that 2 people looking for nothing but mutual satisfaction will follow the path that leads to love because that’s how 80s and 90s babies are dating.

Really?  

Let me set the stage for you:

Emile had a … well, I personally did not believe it was a ‘date’ as it was later in the evening on a weeknight at a casual but fun drinking establishment with gourmet pub grub.  The invitation had been sent by text and the response as well.  The boy was looking forward to enjoying the patio and beer AND said so in anticipation.  Emile, taken aback with his response but withholding her witty tongue, brushed off the comment and attributed this to his ‘laid back, casual’ style.  I had mentioned that it was an off comment to make but could be nerves or whatnot, and the ‘date’ was set.

Before heading over I offered a bail-out call from my work (to make it seem official, of course).  Throughout the night I received positive messages, how much she liked him, how well they were getting along… and I passed on a piece of advice given to me by my friend Bobbie: “Make good decisions”.  She had text me that very message 3 hours into my first date with JD, and seeing how I was on my crimson wave I happily (drunk on 4 glasses of wine) text back that the good decision had been made already by my week free of birth control.  Years later JD and I are happily coupled, and Emile mentioned this the days before her first date that, although meeting in similar circumstances, my situation turned into a relationship and that she was not ready or looking for serious commitment.

The next afternoon (hey; I like to sleep in!) my phone buzzes with the note of Emile confessing that she may have made bad decisions.  Seems the night went SO well it continued into the morning, and boy had just left.  Being mature adults the mutual satisfaction that had occurred was met by both as a ‘fun, casual, laid back’ event and that she was looking forward to the next time seeing him.  Luckily (?) for her, the next time would be that evening, meeting up late again, dancing with a group of friends only to retire together for another midnight session.

Text messages would follow and I would hear all about it; and each time I asked if that now, would a proper date happen.    These questions were met with halting answers: Emile did not want to pressure boy into fancy dinners and public outings, she was happy with backyard talks and sleep overs, text messages over phone calls and avoiding the drama and complexity of the beginning stages of a relationship.  This ‘thing’ was just what she was looking for; easy, laid back, no effort, no pressure or demands that ‘other girls’ would place on men in a dating situation.

But that is how far it went.  A few text messages throughout the day and the final being a booty ‘call’ found Emile confused and frustrated.  Why wasn’t he putting in any effort? Why must I suggest activities beyond what we’ve already done?  Why aren’t I meeting his friends? Why won’t he join me with mine?

The next few weeks I was flooded with ‘If he doesn’t start putting in effort I’m going to get bored and move on’ when clearly boy had already done so.  The difficult and equally frustrating task of tiptoeing around the fact that:

a) fucking on the first date sets a precidant of continued and further fucking without anymore effort

b) casual and laid back = no commitment, no rules, no accountability

c) he just doesn’t have to DO anything to get you in bed

raised my already climbing pulse and blood pressure.  Finally I wrote back exactly what she was looking for with a guy: someone to date but not date officially, someone who was allowed to ‘see’ other people but not fuck them, someone she didn’t have to call or be supportive of in work, school, money, activities BUT would show progression in meeting friends and family and put in visual effort in activities and planning a week in advance for outings.  Turns out that is exactly what she wants, and all I could say was “great!”

For someone ( and it’s not just her; I can rattle off a gaggle of girlfriends with similar perspectives of post modern dating ) who proclaims to want an ‘easy, casual, uncomplicated, drama free, laid back thing’ –  the above addenum that sounds a hell of a lot like work.

A LOT more work than “Would you like to have dinner with me?”… “I am not dating anybody else.”… “It’s been 6 months, I should probably tell my mother about you.”… “This is my girlfriend Chloe.”

I can understand the appeal of an easy arrangement: it allows a slow re entrance into the dating world while satisfying a carnal need for sex and a human need for companionship. But if that’s ALL that you want, be sure to STICK to it.  It isn’t fair to entice a guy OR a girl into an arrangement that begins mutually beneficial then turns into a backdoor crack into a “well we’re already here so may as well be a relationship”.   It’s like promising me Michael Kors and showing up with Payless.

Now I’m not saying that anyone who agrees to this situation is akin to a pair of Payless shoes: on the contrary, they are usually the Michael Kors of the dating scene.  Emile is a pair of Michael Kors shoes.  She is beautiful, she is smart, she is employed, living on her own and doing just fine.  She is a girl worthy of effort – effort as simple as a 7PM dinner on a Sunday night.

And you are too.  So why would you waive that right to a proper date?  Because you think that’s an easier way to attract a man?

Well, you’re right.  It IS an easier way to attract a man.  But what after will keep them? The goods have been given: the V-power  vanquished at your own hands and the mystery and anticipation dismissed as a barrier and not the best damn foreplay you’ll ever have.   Plus, even if you DO wait before fucking, what more can he or she gain by committing into a relationship with a person they didn’t want one with in the first place?  Why would they give up a guaranteed lay while remaining on the prowl for more? It’s essentially the best deal EVER: automatic sex with a hot guy/girl while continuing to date for more potential sex.  Giving that up IS a commitment, no matter how you say it.

I guess what I was trying to convey is that before entering a FWB situation, you have to be real with yourself and your expectations.  If deep down you want something that might resemble a committed relationship despite your denial, be honest with yourself before entering into a fuck buddy arrangement.  If you want more, you gotta tell them: because the last thing you want is to waste your time while leading someone else on who actually knows what they want and are mature enough to handle getting it.