And It’s Surely To Their Credit

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The West Wing – And It’s Surely To Their Credit

Because of you I am a good nurse. 

My favourite preceptor never introduced me as his student nurse to the surgeons, I was always his sidekick. The first time I played scrub nurse it was for the morning orthopaedic list with the upper limb surgeon. After I carefully scrubbed in his presence, managed to slip on both sets of sterile gloves without ripping them, and didn’t contaminate myself all the way to the operating table, I went to introduce myself to the surgeon. I was terrified that he’d refuse to have a student nurse on her first day in theatre scrub for him. He had every right to feel that way too – I had absolutely no idea what I was doing. My preceptor slid in beside me, freshly gowned himself, before I could even speak .

“This is Dannielle, my sidekick, she’s gonna scrub for you,” he said, and even behind the mask I could tell he was grinning.

“Well, goody,” the surgeon said in his polite British accent. “Skin knife and artery forceps to start please sister.”

“Yes, right away,” I’d said, smiling widely even though he couldn’t see that part of my face.

I spun around and turned to my preceptor in a panic. Which one was the skin knife? I had learnt 10 and 15 blade. What in God’s name were artery forceps? He laughed at my expression and called to the surgeon.

“Ya know Matt normal people say 10 blade and a haemostat, give the poor girl a chance, she doesn’t speak British.”

The surgeon laughed and rolled his eyes, and I handed him the instruments, feeling stupid. My preceptor didn’t allow me to feel stupid for long. He let me scrub for countless procedures, taught me how to be a circulating nurse, and annoyed other scrub nurses until they let me observe their surgeries – a kidney transplant, a liver transplant, an aortic valve repair, and a coronary artery bypass graft (CABG). Having a preceptor who teaches with the same passion with which you want to learn undoubtedly shapes one’s career as a nurse, they help make you into the kind of nurse you want to be.

During training, other nurses overwhelmingly influence what sort of nurse you will become when you graduate. More often than not they guide and teach you, showing you how to be a competent nurse, but one can learn just as much from poor experiences, learning about the kind of nurse you don’t want to be, the behaviour you want to improve and learn from. I carry all of these experiences with me as a graduate nurse, because now I am the nurses that taught me, patients are my responsibility, and I have students of my own to teach from time to time. However nurses are not the only ones who influence us in our path to become RNs, there are many reasons we even come to nursing, and so many people who shape those ideas. For my first year as a qualified registered nurse, I would like to pay respect to those individuals and thank them for the nurse that I have become. 

The Teacher

I am fifteen years old, in year eleven, hell bent on going to medical school. I sometimes wish I had a curtain to hide myself behind, because the voice in my mind makes it hard to see anything good about me, only problems to be fixed. Control is the only drug I need, and it’s an addictive one, one that leads me to the bathroom lunch time early in September. I have chemistry in fourth period, but my mind is thinking of other things. The ritual is terribly familiar by now. I choose the farthest cubicle, checking to see that there is no one around, and attend to the cutthroat business that is making myself sick. Then I go about the other business – hiding it. I rinse my mouth with mouthwash to kill the smell and get the acid off my teeth. I place a cotton pad soaked in icy water around my eyes to stop the redness and stinging, so I do not draw suspicion by looking like I’ve been crying. I smooth my clothes and follow the command from my mind to act normal. I make it to chemistry class, my facade holding, I make it all the way through class too, even though I feel a panic attack coming on, because a familiar feeling is beginning in my lower abdomen. Pain. When the bell for end of class rings I walk along one of the upper levels of classrooms, away from the rush of people who might notice that my mask is cracking, because my heart is racing, my stomach churning – from anxiety or as a side effect from vomiting it is unclear, but it hardly matters. I see my biology teacher, my heart races faster – I am bad at maintaining this face around him, he sees right through it so often, he is too nice and I feel guilty for lying. But this is a secret that burns everyone who touches it, so I always try. Today something is different though, I don’t know what, perhaps I have managed to wrestle back control from “her”, if only for a moment, because when I smile and wave at him, strolling past quickly, he turns back. When he asks me if I am okay, I say no – against better judgement, against her screaming voice, even though I know it may mean the end of my secret. 

I learnt the first thing about being a good nurse before the thought of becoming one even occurred to me. From my high school biology teacher I learnt what it meant to do more than the confines of your job description, because when you care for other people duty calls you someplace higher. To have the privilege to care for, teach, or mentor others as part of your job is to understand that people are more than the task in front of you, they are more than a policy, and more than what you can ever be taught in university. When I told my teacher that I didn’t just spend my lunch times not eating, I spent them throwing up too, I expected him to panic. I figured it wasn’t part of teaching curriculum to know how to deal with teenage bulimics, you just passed them on to people whose job it was to fix them. I expected that maybe he would say that he was sorry, but he had to drag me kicking and screaming to our school’s guidance counsellor – who I was not a fan of. I even expected that maybe he would be sad, and ask me why, why did I do this? How could I like throwing up, perhaps he would ask – like the school’s deputy principal would ask two months later when he found out. He didn’t do any of those things, there was no panic, there was no passing me on, no dragging, For many weeks and months after that day he listened to me, helped me figure out what I wanted to do, and let me realise on my own that I wanted to stop, and was there for me when the time eventually came to tell my parents, he even called my mother when I was too nervous to go home and face her. During this time he never let me forget that I was enough – smart enough, good enough, capable enough, and soon I started to believe it too. He wasn’t obligated to do any of this in his role as my teacher, but he did anyway, because it was what I needed. He realised that what I told him was the hardest thing I have ever told anyone, and respected the kind of honour associated with that. I trusted him enough to tell him my darkest secret, and he never let me down.

My teacher taught me what it meant to be empathetic, and not just do a job, but be genuinely passionate about what you do – enough to go the extra mile without missing a beat. When I admit a patient for surgery, or care for someone on a ward, or attend to an emergency patient, I have a list of requirements that I must fulfil. I must abide by policy, professional frameworks, refer to my knowledge and assessment skills. If by the end of a shift my patient has had their prescribed interventions, I have helped them with activities of daily living, prevented harm, and reported deterioration to doctors – my job is done, legally and professionally. I am busy in a shift, and sometimes there is not time to hold hands or give reassurance – but I do it anyway. My patients are more than a list of tasks to complete, and my job is not just to carry out such a list. I make time to listen to these conversations, because it’s an honour to be chosen to hear them. If a patient trusts me enough to tell me they are scared, I must give them the respect of my attention and my comfort. This comfort isn’t an extra, it is part of being a nurse, and why I became one.

Thank you for teaching me the power of empathy to help and empower another person, because of you I am a good nurse.

The Doctors 

Frank

To become a nurse, or any health professional, is to learn a new language – a plethora of jargon and acronyms that become part of your everyday vocabulary. You don’t go to the toilet – pt PUIT. No more do you eat three meals a day, one “tolerates diet and fluid”. To enter an environment where people freely use this language is akin to travelling to a foreign country. This is how a patient feels when they enter a hospital. As well as this new language, one learns a new set of social rules and skills. In real life, we learn our social skills through experience and develop schemas, we observe and put into practice that which we have observed. In nursing world, we have to learn this all over again with interesting new observations. No one ever taught me the appropriate conversation to have with a patient when they’re half naked, or when you’re violating their personal space, or how to ease the awkward silence that exists as you stare at someone’s chest to count their respiration rate. However there is a doctor that stands out who taught me that all of these things can be done, and done well, and his name is Frank.

Frank and I met in my first semester of nursing school and three months after my laparoscopy. I was sent for a scan as a follow up after surgery and to ensure my IUD hadn’t attempted any sort of breakout from my uterus, because perforation of any organ is absolutely no one’s friend. Those endo sisters among you will know said scan as the delightful process where one lies with an ultrasound between one’s legs for twenty or so minutes and tries to focus on something other than the fact that this is the least fun you can have without your skirt on, ever. Frank was uniquely gifted at conversations you can have without pants on. Within five minutes we had covered our shared university alma mater, how he thought nurses were the greatest thing to happen to the world, and several jokes about the absurdity of a former premier’s head. I laughed, I felt comfortable, and yet I still wanted to throw up, and my endometriosis flared up which made things fifty shades of shit. He managed to seamlessly swing from laughter and manner that could only be described as ‘jolly’, to quietly asking me if I was alright and reassuring me that everything would be okay. I am one of those people who cries stupidly when people are nice to me, so naturally I went right on cue. This doctor did not make me feel stupid for feeling this way, he didn’t tell me not to cry or that there was nothing to worry about – because clearly for me there was. He just patiently waited while I let the anxiety out, offering a helpful hand on a shoulder, or sympathetic nod. Then when I was ready he went right back to his jokes.

Sometimes the only way is through. In nursing I cannot dance around the fact that something will be awkward, or that it will hurt, but if I act like I am asking them if they’ve seen any good movies lately, rather than whatever organ system I am focused on at the moment, things go alright. Patients can read you like a book, make no mistake. If you act like what you’re doing is a big deal, or makes you nervous, they will mirror those feelings. Frank taught me the importance of treating the awkward as routine, while still acknowledging the foreign environment the patient finds themselves in. You must be as prepared to make small talk as you are to hold hands, and treat both as a completely normal part of the process. I am still not as adept at these situations as Frank, but I have a standard to aspire to.

Graham 

The first time I left Graham’s office, I cried for a long time; it wasn’t because I was sad, not really, despite much talk of surgery and endometriosis. The only thing I was sad for was the knowledge that before this I had accepted less than being taken at my word. I cried with an unusual mix of relief and something unidentifiable, because I had never felt so understood in all my life. I’ve written plenty in the past about how I have been so fortunate to have a great specialist, but it cannot be understated how greatly this treatment has impacted on how I treat my own patients. It’s not only how his kindness, patience, and consideration made me feel better, it’s how it empowered me to trust myself and become my own advocate – because not every medical professional will understand or even try to understand endometriosis, sometimes you have to be the one to push.

No matter how many times I find myself sitting in the same spot in his office, usually three months too late, to tell him that things have not been so good, he acts like it’s the first time I’ve even bothered to ask. There may be some theatrical sighing and a head shake as he tells me that for a nurse I am a terrible patient, but every word I say is taken seriously. If it matters to me, it matters to him. If there is a story that goes with it, he listens. It’s not so hard to figure out what patients want on a basic level, they want to be heard, to feel like what they say matters, that the person they are telling cares. A few times during an appointment he has answered a call from one of his children or another patient, always apologetically. Some people shake their heads when I tell them this, saying that he could have waited for me to leave, but I see it in a different light. The people who call know he is a doctor, and a busy one, so for someone to call and expect to be answered, it must be important. I know from my own experiences that knowing someone needs you and not knowing why can be twice as distracting as just simply answering and figuring out what you can do later, and reassuring that person that they are heard. To me that shows genuine care, and if he treats his family, and his other patients with this respect, then surely I too am in good hands. In nursing it is so often that our care goes unnoticed because it is out of sight – the phone call to a doctor at 2am to demand they come and review a deteriorating patient, the care I take to have a medication checked before administering it – but  I am okay with that, because I do not care to be acknowledged, I do it for the patient.

I find myself each day on the ward using some classic “Grahamisms” – a joke he’s made to make me feel better, emulating a reassuring expression, or simply trying to think what he would say if this were me, or one of his patients.  All of them have helped me with my own patients. More holistically, his attitude of listening to the patient narrative and allowing it to be one of the major tools for assessment is something that influences my practice. It is the reason I listen with interest as someone tells me the story about their grandchildren, because sometimes it’s important, and give a clue to something we may have missed – depression, decline in mobility, cognitive problems. Patient stories matter, and part of providing true patient centred care is seeing the patient in their world, rather than the artificial and controlled world we create in hospital. Graham taught me that health professionals can make differences in people’s lives, big ones, and though our names might be forgotten, and our faces may fade away in their minds – patients will never forget the care we provided or the safe and reassuring place we created for them.

Thank you for teaching me the real life meaning of patient-centred care, and how empowering it is as a patient to be heard, and understood. Because of you both I am a good nurse.

The Matriarch 

My Nanna was 77 years old when she died, which seems far too young in an age where life expectancy for women is over 80. The disease was metastatic breast cancer, the cause liver failure, the complication urosepsis. Nanna always wanted to be a nurse, she once told me, a theatre nurse, just like me, so that she could watch surgery all day. Nanna never turned away from blood and gore, she loved it, even when she claimed she didn’t. I was in my first year of nursing school when she received treatment for a relapse of her primary cancer, and was taking my final exams the week she passed away. The day she found out that she wasn’t going to make it, and that mere days remained, she was braver than I thought possible. She held things together after an initial outpour of emotion, she began charging me with the responsibility of making sure each granddaughter would have something of hers, and what of granddad’s would be left to her grandson. She and I attempted on that first afternoon to cram what should have been another twenty or so years of love and life into a short space of time, knowing that each word came from a stolen moment and borrowed time.

On the third day the ward’s nurse unit manager came and told me that she heard Nanna wanted to see her dog one last time, and told us that if we could sneak her in, she would let us. Nanna was already on a NIKI pump, filled with medications to ease pain and keep her sedated enough not to feel any distress, but when Chloe came to sit on her bed, I swear I saw her smile one last time. The nurses sat at the door, trying to catch a glimpse of this sweet moment and smiling. This was a simple gesture, but it no doubt meant everything to Nanna to see Chloe one last time. She saw her three sons, two of her granddaughters, her best friend and her dog – she could go now. She didn’t wake up again after that day and died two days later. The nurses in oncology talked to her as though she were still answering, they did turns and care as though preventing pressure areas at this point really mattered, because my Nanna, no matter how close to the end, was still a person who deserved comfort and care. Those nurses were exactly what I wanted to be, but it was Nanna who taught me what it was like to be the one dying. She taught me that there is no textbook way that things go when you hear that the end is coming, and that it is possible to be brave even when inside you are not. Nanna lived a life for others, and that was how her life ended too – she was strong for us, even when it was us who wanted to be strong for her. At her funeral my father described her with a line from Bruce Springsteen – courage you can’t understand. That has been true for so many patients I have cared for. I look at them and wonder how they don’t just cry all the time, how they manage to make jokes and compliment my hair or my colleague’s tie. They find something, some place inside them, and keep going despite their circumstances. My patients have been the best teachers of all. They help me understand what it is like to be vulnerable or scared, or confused, and that these emotions matter. They are more than their disease. I have been the patient myself, and for so long I didn’t think much of myself, and for that reason I accepted it when people dismissed my pain or didn’t take me seriously. Once I found a doctor who helped me realise that I matter, I knew I never wanted any patient to feel the same way. My patients are the reason for my job, and they teach me something new every day. I see Nanna in them each day, and for her, and them, I do my very best.

Thank you for teaching me what it is to be a patient, how we as humans can handle even death with grace and dignity, and that loss changes families forever; and how I help families deal with that can also change them forever. Because of you, I am a good nurse.

On my final day of theatre placement I scrubbed for the same surgeon as on the first day. Before he even turned to ask me I handed him a yellow sharps tray and held in my other hand a haemostat.

“Skin knife and artery forceps,” I said.

“Thank you sister,” he replied.

“You know I’m not a nurse right? You don’t have to call me sister, I’m a student,” I told him.

“I think I’ll call you sister,” he said. “You’ve earned it.”

My preceptor stood to the side, supervising but letting me do the case alone; I could see his eyes smiling behind his mask.

“Thank you,” I whispered.

To every preceptor, every patient, every doctor, and friend…to every family member, every other student nurse who made it through with me: thank you for making me more than just a good nurse, but a great nurse, a nurse in progress who humbly presents herself each shift to patients and other colleagues to ask – what can I learn today?

To every nurse and midwife reading, Happy International Nurses Day sisters!

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Better Than Anaesthetic

The Realities of Being A Nurse With Endometriosis

Drain the pressure from the swelling
The sensation’s overwhelming
Give me a long kiss goodnight and everything will be alright
Tell me that I won’t feel a thing
So give me Novacaine. 

Give Me Novacaine, Green Day.

The pain has been ebbing and building for two hours when it changes to constant, and stabbing. The feeling of nausea is subtle, but it too grows, as does a hazy feeling inside my head that is the precursor to dizziness. I am sitting at a table, where it’s easy enough to hide these things, and I occupy myself with the lists and tickets in front of me, I smile at people as they walk in – no one knows except the person beside me, because I have attached a blister sheet of paracetamol to my clipboard. We all laughed at first, about how nothing would stop me being at this event, not pain, not anything, and so I have meds on hand, naturally. When the first wave of intense nausea comes my hand rushes to my mouth. My colleague tenses and hands me a bin, but I have no desire to vomit in a bin in front of everyone, especially as I see my doctor seated in the back row in front of me – I pray he doesn’t turn around and see me. When I return from the bathroom I sit on the floor at the back, feeling as though I may pass out. I recognise a pre-syncopal episode when I see one, and now I am feeling it. As I sit I look at the back of my doctor’s head, willing it to stay turned away from me. I can feel the eyes of my friends on me, worried, wondering what they should do. I sit filled with guilt that they are worrying about me, instead diverting their full attention to enjoying the fruits of their labour. Don’t look back, I think to myself, watching his head; don’t look back and see me.

I can already hear your question, reader, why didn’t I want him to see? What luck, I hear you say, to be feeling horribly sick with an endometriosis flare up and be sitting in an event surrounded by nothing but other women with endo and your doctor. The thing is, the very last thing I ever want is to show other people how sick I am. I wonder if it’s because I want to hide it, because I don’t want pity, or if it’s denial. If no one notices, it can’t be that bad, right? It’s learned behaviour from my days as a teenage bulimic – showing symptoms was synonymous with showing my secret and I avoided it as much as possible.

Perhaps it’s because my job involves caring for other people, and when taking care of others we instinctively hide our own distractions so that this person knows we are focused on their needs. This relationship won’t work nearly as well if the other person thinks they need to take care of us. I can still remember a shift as a student nurse where I had no choice but to go home sick because I couldn’t push aside how ill I felt anymore, I had pushed too far and nearly blacked out in the middle of a blood sugar check. The patient in question looked up at me and asked “You right nurse?”. I nodded and smiled, telling him that he needn’t worry about me, I was making sure he was okay. I finished – just. As soon as I wrote down that value I walked quickly to the bathroom where I felt my legs give way and I sat on the floor until things became clearer. Even then I knew that I couldn’t let my patients see my pain, ever, because I was not in the business of patients worrying about me when it’s my job to take care of them.

Nurses make the worst patients, don’t they?

When I started nursing school I saw patients with the same problem, the kind that told me they were fine and wanted to go home, and then nearly passed out walking to the shower. Patients who didn’t want to bother me by asking for pain medication and only relented when they were wracked with pain and I held their hand as my colleagues administered strong pain medicines. If I hadn’t already appreciated the danger of denying symptoms before then, nursing school certainly reiterated it. But it didn’t seem to be enough, I still reverted to my standard defence mechanism. Final semester of nursing school, September, my pain which had been well controlled for close to eighteen months, began to act much like an unruly child. Since my surgery and IUD insertion, and a few months of hellish pain, my overall pain was reduced 90% of the time. Once or twice a month I may have gotten pain bad enough to effect my functioning, and a few times a month some pain in response to stress or too much sugar when my best friends and I tried a spree of new dessert places. It was more than manageable. I was doing so well that I joined QENDO as a support worker, flew through my accelerated nursing course, and dreamed lots of dreams that seemed out of reach before – I hadn’t thought I could stand for hours in an operating theatre as a scrub nurse in pain, but now the pain was gone. I fell crazy in love with theatre nursing, and thought the feeling of joy would never go away.

In my final placement everything went completely and categorically to shit. The pain was back most days each week, some mild, some moderate, and some straight from the fiery depths of hell. Those days, combined with the stress of a placement that made me more anxious each shift, made lunch breaks no longer for lunch, but for finding a bathroom to cry or have a panic attack in where no one would see. I hadn’t experienced pain so horrific since before I was diagnosed. I blamed it on my placement – anxiety is fuel for a flare sometimes, surely it’s because of that, I thought. Placement was over, and still the pain stayed. I blamed it on job hunting – that was stressful too. By February I had secured a graduate job for March, my first real nursing job, and yet the pain did not go away until there I was sitting on the floor of a lecture room at UQ trying not to pass out. There was nothing left to blame – I loved my new job, my new role in QENDO, I finally had my own place. There was one question now – what the hell was happening to me?

The task of tackling nursing and endometriosis is a challenging one. At times I feel like I know too much because of my nursing background, and only sometimes is it an asset instead of a liability. It is great to know exactly what doctors are saying to me, or to be able to advocate for myself because I do it all the time for patients, but sometimes I don’t want to know – knowledge can be both a blessing and a curse. The greater issue is one I get asked about a lot – how can you work in so much pain?

The truth is that nursing is the best thing that ever happened to me for coping with pain. When I am in my uniform, or my scrubs, on a ward or in an OR, I am someone different. My endometriosis doesn’t exist for eight hours. I feel it tug and pull, like a child on its mother’s skirt, but I do not look down. By some feat of strength I can push the pain into the background, as long as I keep moving and keep working – and a shift at my hospital leaves little time to be idle. My work is what helps me survive. Being a nurse makes me feel in control because when something happens I can intervene. Pain? Have some PRNs. Nauseas? Have some antiemetics. Strange, new symptoms? Let me page the resident for you and reassure you that everything will be okay. When I feel any of these things myself, I feel powerless, sometimes there is nothing I can do. The pain of endometriosis is such that often no painkillers touch it, you feel violently nauseous, pale and dizzy, and the weight of it crushes you. The feeling of stasis makes me uncomfortable, anxious even, and so when my endometriosis flares up I feel out of control, it slips through my fingers. If I didn’t have my work, I’m afraid of what I would do to get that control back. Nursing is better than any pain killer, better than anaesthesia – for just eight hours.

And there in lies the problem, it’s temporary. As soon as I get home and there are no more buzzers to answer, or IVs to change, or people to take care of I have to take care of myself – and I am really bad at it. If I treated patients the way I do myself, if I ignored their symptoms, denied them pain killers, or just let them feel sick, I would be a terrible nurse. So why do I do it to myself? From talking to a lot of other endo sisters, I know I am not alone in this problem. Part of me wonders if it’s because we have been doubted, pushed aside or dismissed for so long that we cannot indulge ourselves, because we feel guilt about being selfish, or worried that people will think we’re “sick again” and tire of us. If we pretend everything is fine and act normal, no one can hurt us with a lack of understanding. Perhaps it is a strong desire to just be normal, after being sick for so long. There is an element of denial. I recognise that in myself – I didn’t want to believe that the pain was “back”, it was just a little flare up, something I did, something I needed to fix. If the pain wasn’t back then no one needed to know, and I could keep pretending.

As carers we need to remember to engage in self care. We must refute the notion once and for all that self care is selfish, or indulgent, or some kind of privilege we must earn. It is none of these things, it is a necessity. How can we as nurses, or health professionals, or counsellors, or parents expect to care for our charges if we have not taken the time to care for ourselves? It isn’t easy, as part of our role we are often conditioned to put others before ourselves, and that attitude doesn’t leave us at the door as we leave work. It can be an ongoing challenge to change this attitude, to learn to say no and take a minute to ourselves, to stop denying. I have no easy answers for you on how to achieve this, it is my own project at the moment, I am learning these things for myself. It has been helpful to ask myself – if I were my patient, would I accept this treatment?

I encourage you to create your own self care toolbox, whether you’re a nurse, you have endo, or you’re a special hybrid nurse-endo sister like me. For endometriosis, every professional I have had the pleasure of talking to has recommended creating such a tool box. Who are your people? What can you do for pain relief, both pharmacological and non-pharmacological? What are your coping strategies? Who are your endo team, the health professionals you can access to manage pain and stress? Most importantly, be kind to yourself – if you live with endo and you generally exist and function, even just a little, you are doing so incredibly well. It is not an easy burden to bear, but I have seen so many of us bear it with grace and optimism.

And so it is with my own advice in hand I once again embark on the task of controlling my pain; I venture into the medical world not as RN, but as patient, to once more find a new GP, despite it being my least favourite task, because pain is no one’s friend. I lived in pain before my diagnosis for so long, so I owe it to myself not to live that way again. I owe it to myself not to pretend that there is nothing wrong, no matter how easy it is to slip back into that habit.

It’s okay for him to turn around now.

“Do You Even Know What I Do In There?”: Media Representations and the Nursing Profession

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“Luca do you even know what I do in there?” Abby Lockhart asks Dr Luca Kovac in fictional medical dram ER. Abby’s frustrated question about her role in the emergency trauma echoes a question asked by many a real nurse when dealing with doctors, medical students, patients, their families, and members of the public. Medical television shows are some of the worst offenders for the representation of nurses, and while ER can be said to be better than others for actually portraying nurses in the main and supporting cast, none have quite given nurses the portrayal they deserve. Is this part of the reason that nursing is still such an undervalued position in society? There is a definite failure of most people to appreciate the professionalisation that has occurred in the profession over the last twenty years, and it’s not just laypeople. One thing medical television shows do seem to accurately capture is medical students and young doctors’ underestimation of the value of registered nurses.

The photograph above is the group shot from season 6 of ER. There is one thing common to almost all season photographs for this television show: only one registered nurse is ever featured. For the first six seasons it was Carole Hathaway played by Julianna Margulies, then Abby Lockhart (Maura Tierney) until she entered medical school in season 10 which made way for Samantha Taggart (Linda Cardellini). The nurses that have been there long term (Haleh, Lydia, Connie, Lily etc) are considered merely supporting cast members and their nursing role is featured only in relation to doctors’ orders. Additionally, their portrayal is often highly stereotypical with the group often sitting around the desk gossiping and laughing while dismissively telling residents that they’ll get to their patients soon. The “main” nurse is never portrayed like this, and the portrayal of Carole, Abby, and Sam are some of the better I’ve seen though their roles have become more outdated as the profession continues to grow (Carole for example ran from 1994-2000, an era throughout which nursing began to see great changes in education, training, and responsibilities). However both Carole and Abby expressed desire to become doctors after feeling disenfranchised with their roles in the emergency department, with Carole scoring high on the MCATS and Abby entering the series as a medical student who returns to nursing after her ex-husband fails to pay her tuition. Abby eventually succeeds which necessitates the entry of Sam in season 10. While the role of the nurse is portrayed fairly well for the time period, the series underestimates the number of nurses in relation to doctors, and assumes that most nurses secretly yearn to be doctors. The tension between nurses and young doctors is best expressed by Carole in season 6 when Lucy Knight, a medical student, makes the brash statement: “you can’t just do that; you’re a nurse and I’m…”. Carole cuts her off angrily saying, “you’re a what?! You’re a med student”. Lucy already has taken on the doctors tell nurses what to do persona as only a fourth year medical student. In shows such as House MD and Grey’s Anatomy nurses have an even less present role and often exist only as people standing in a patient room or as sexual conquests of the doctors. Their role is not only subordinate rather than in partnership with doctors, but they generate very little of their own care and instead sit around and wait to be commanded by a doctor. In House MD, no doubt to enhance the comedy that is House’s personality, nurses are often addressed crudely and made fun of and, again, frequently serve as sexual exploits or girlfriends for doctors like Chase and Taub.

With portrayals of nurses like this in some of the most highly consumed television programs how can we expect patients to think of us as highly trained professionals who have a semi-autonomous practice, and who work with doctors as part of a team instead of as placid, smiling assistants who simply do everything doctors tell them? The role of nurses needs to be public knowledge, otherwise we cannot expect our patients to know that they can ask us certain questions, or expect a high standard of care. Even upon telling people closest to me that I was going to be a nurse, many of them doubted that I would actually do it or assumed that I would later go to medical school. That’s because they had it in their head that nurses do things like fetch juice or water, clean bed pans, and shower people. While these may be some of the things RNs are expected to do, many of these tasks actually now (in Australia at least) fall to enrolled nurses (Diploma as opposed to degree trained) in large hospitals where one is fortunate to be part of a team of nurses. In smaller hospitals or primary care RNs may do more of the above duties, but it is a small part of patient care. In modern nursing you’ll find us in the operating theatre, as scrub, scout, or anaesthetic nurses; as nurse educators, consultants, or managers. The role of nurse practitioner is an interesting one which has come about in the last twenty years or so. Nurse practitioners undergo advanced training and can order their own tests, refer patients to specialists, and prescribe medications. In Australia this role has helped to relieve pressure on overcrowded GP clinics and as an extension overcrowded emergency departments. Nurse practitioner run clinics mean that minor illnesses and routine care can be performed by nurse practitioners. These clinics have since expanded to include some GPs for extended emergency care after hours that would otherwise result in long wait times in busy emergency rooms.

When asked what a doctor does, one generally has an excellent idea. Even when asked what a specific doctor does such as a surgeon, obstetrician, or cardiologist, most people still have a pretty good idea of what that entails. How do we get people to recognise what nurses do in the same way? How do we help patients to understand the different levels of nursing (i.e. Assistant in nursing, Enrolled nurse, Endorsed Enrolled nurse, and Registered nurse) and what this means for them? A better understanding would help patients better comprehend hospital resourcing and understand why certain staff can or cannot directly attend to a request (for example, an RN is running to an emergency and a stable patient requests water or food…they may have to wait just a little because an RN needs to be present in an emergent situation). Furthermore the role of nurses is often extremely undervalued with many members of the public or even hospital staff believing that nurses do not participate in complex care and do only basic tasks. Thus when nurses attempt to gain better conditions, pay, or benefits people are quick to ask: do they really deserve it? Damn right we do…and here are some examples: In post-anaesthetic care nurses take the reigns. Long after the surgeon and anaesthetists must move on to their next surgery, the PACU nurses care take care of patients’ pain, emotional health, and are on the look out for post-surgical complications that can be fatal if unnoticed. The scrub nurse is an essential member of the surgical team with many surgeons adamant that a sharp and educated scrub nurse makes their job easier and safer. A good scrub nurse knows the procedure the surgeon is doing so that, for example, if the surgeon calls for scissors but the nurse sees the patient is bleeding she realises the surgeon means a clamp and anticipates the mistake before it happens, saving time and the patient’s life. An ICU nurse must juggle the complex care of a patient who may be on the verge of death, while many specialists come in and out they must ensure medications are given correctly and look out for overprescribing or adverse reactions

The roles of nurses are varied and take on many forms, and it’s time more people knew it. Respect for a profession that touches so many lives is essential in modern medicine and public education about the role of nurses and their position within the health care team could help immensely with this. Nurses should not be so undervalued by so many for a job that would be obviously missed if every RN, EN, and AIN failed to go to work tomorrow. Do yourself a favour and educate yourself about the many different health care roles, especially if you have frequent contact with the healthcare system. In the majority of cases, the people that care for you are passionate about what they do and have worked hard to get there. Many of your nurses have Masters degrees, graduate diplomas specialising in their clinical area, as well as their qualifying degree. They work hard every day, often nights and weekends, often sacrificing time with their own families. It’s time we recognised the value of this work once and for all.

Feeling The Calling

wesley-nurse-smiling-at-patient

Actual angels in plaid scrubs… yes plaid. The Wesley kit their surgical team out in only the best. 

In September I applied to a new degree. I’ve just completed my Bachelor of Arts in English Literature and Criminology, which hails from a time where I was going to be teacher, and next year I’m starting something new. The very first thing I ever wanted to be was a nurse, before I even really fully understood what it meant to be one, before I moved on to wanting to do medicine in year 10. I decided I wanted to be a teacher after that and nursing was forgotten until my second year of university. I remember suddenly missing the medicine, exacerbated by long study sessions in the Mater Hospital library where a table of happy nursing students let me sit with them while I studied a potent combination of physiology, statistics, and modernist literature. They were so nice and incredibly grateful for my physiology knowledge which more than once helped quash the frightened stares that ensued after one of them would read a tricky question. Hearing them quiz each other on  nursing topics and being more interested in said topics than my own coursework changed my mind soon enough and I began to research whether switching to nursing was a thing that I could do. That was when I found the awesome graduate entry degree Master of Nursing Studies which lets you do a nursing degree in 2 years after your undergraduate degree, as long as you’ve done at least one undergrad science course (thanks physiology!).

That was it. But even so, I was pretty sure I was only imagining what I wanted and, like anything, I questioned if I had done the right thing. Changing a well thought out plan to something completely new has that affect, and my head swam with possibilities. Should I just go to medical school? Nope, too much chemistry…and one first year anatomy class taught me that I was not great with cadavers, or origins and insertions for that matter (thank you nursing and your awesome mannequins that are NOT cadavers!). Should I just be a science teacher to get the med feels back? Not when the biology curriculum is 62.5% plants and animals,25% genetics, and 12.5% human stuff.  No, nursing was certainly what called me the most; I had sort of, kind of, felt the calling. A very recent experience changed all that, I felt the calling for real and I knew it was for real because I’d never been more sure about what I wanted. Like a nun seeing a vision of Christ, I felt changed.

The moment came  last week as I sat in a tiny room in a rather billowing hospital gown with an angel in plaid scrubs (yes, I said plaid) named Mel. She was sweet and kind, and was the first of many nurses that day who would try to keep me calm even though I was petrified. She made jokes about the attractiveness of theatre attire and complimented my hair as she tried desperately to get it out the way of pretty much everything she was doing. Mel was the first but not the last of these angels in plaid scrubs who helped me through my surgery.  These women were amazing and it wasn’t a superhuman gesture that made it so, it was every small gesture. It was the way the nurse running the board gave me a toasty blanket and asked “you good?” with a smile as I was transported to theatre; the way the nurses in the post-anaesthetic care unit reassured me, promising me everything was okay as I woke up in my drug-induced confusion; and the nurse in recovery who tried her best to decipher my chart and provide me with some answers in an attempt to quash the anxiety that nothing had been found. As I went into the theatre, and met the rest of the surgical team, I thought how much I wanted to be just like them when I became a nurse.

The nurse who I absolutely wanted to be more than anything was the anaesthetics nurse who held my hand and cracked jokes as the anaesthetist tried to find a vein (I’m apparently a terrible stick). She seemed in love with her job, even the part that included getting me tissues. She came to see me to ask the standard set of questions a third time over when I was in the holding bay. If you’ve never been in one, it’s a little curtained cubicle where you wait to go into theatre and you are pretty much all alone. It’s guaranteed to shake the confidence of even the calmest surgical patient, because when you’re alone with your thoughts you often realise how scared you really are. It hit me hard because I was already nervous, and the person who comforted me the most was this amazing nurse. The anaesthetist and my surgeon also came to see me; both were unwaveringly kind and greatly comforting, but something about this woman was even greater. I’ll never forget the look on her face as a chime was heard over the hospital intercom and she excitedly told me, “That means a baby’s just been born!”. That’s an awesome hospital feature by the way, but she looked so happy that it made me feel less sad. Even the anaesthetist, who was still helplessly looking at my apparently veinless arm, looked cheerier. I went home after my surgery feeling like if I ever had to do it again I’d be able to. Better yet, I felt the calling. I knew absolutely that I was destined to be a nurse, to spread happiness and kindness even in the darkest of times; to be optimistic and reassuring even when the patient feels helpless. That’s what I want to be.

I’d been thinking for a while that I wanted to go into paediatrics because I work with children at the moment and for the most part I adore it, my students are awesome and surprise me every day. While there are some that annoy and frustrate me quite a bit, I can always find something about them that makes me smile. Paediatric nurses seem kind of like superheroes to me and I wanted in, and maybe I still do – we’ll see what practical placement brings, but now I may have other plans. Being a surgical nurse, or maybe even anaesthetics, seems like an area I want to explore now because of the amazing people I met. Perhaps still with children, but I’m considering adult surgery more because it’s even more scary to be completely grown up but still find yourself at your most vulnerable. I would empathise with so many of my patients, knowing their fears and concerns because they were once mine. The strength of nurses in any area is admirable and something to aspire to, but I feel a particular affinity with several areas. It’s something I look forward to exploring as I complete my degree.

Expect much nurse blogging in 2016! Feel that calling with me 😀