Tuesday, May 15, 2012

The Image of Nursing and Unrealistic Expectations For All

Writing a nursing blog has been an enlightening experience to say the least.  One of the things that was the biggest shift in thinking for me, sort of in tandem with my nursing career, was the realization that not only am I going to never live up to my own expectations, but I am especially never going to be able to live up to the expectations that the average person in the public has of me.
Let me explain.  I distinctly remember the first time I actually got so mad at a patient that the thought entered my head that I wanted to hurt them.  I feel ashamed to admit that I've thought that way even now. I found it extremely distressing at the time.  Here I was, supposed to be helping this girl, regardless of the fact that she was beyond rude, regardless of the fact that she was non-compliant to the point of being spiteful, beyond the fact that she was obviously drug seeking, I was supposed to be helping her and ZOMG I am thinking about kicking her ass and I have failed as a nurse and a person FOREVER. The only reason I didn't quit at the end of the shift was my charge nurse that night.  She is an incredibly hard working, sweet, and fabulous nurse who I look up to immensely.  The type of person anyone would love to have taking care of their family member.  And when I broke down into tears and told her all the shit that had gone down with this patient, her response? "Whatever.  What a dumb whore."
I could have hugged her.  Not for agreeing with me in my assessment that this patient was awful but in unknowingly confirming that just about everyone, even the most kind hearted and badass of all nurses, sometimes feel this way about patients.
And when you think about it logically, and objectively, it makes sense.  Yes, nursing is a calling, but shit, yes, it's also a JOB.  Who at their job has not dealt with someone completely insufferable and thought to themselves for a second, "Dude, if it were you and me in a dark alley outside of this, I would totally kick you in the teeth." Well, yeah.  It happens to us too.  Actually, probably a lot more than in the general population, because the level of bullshit that people have figured out they can get away with in healthcare is beyond just about anywhere else.  I certainly never had anyone pretend to have a seizure to get their meal comped when I was waiting tables.
Yeah, we care about people, and we want to help, but also like anywhere else, we sometimes we deal with people that are genuinely awful human beings and we recognize this quality in them and dislike them for it.  Sometimes there are days where we see nothing but this.  Other days it clouds our vision to make it the only thing we can see.  Sometimes we get in the mindset that just about everyone is full of shit and any effort we put forth is pointless because it will just go unappreciated anyway, because some days it really isn't far from the truth.  It's really soul crushing and defeating when you get into a field because you want to make a human connection and reach out and help someone and so many of the people you reach out to lie and shit all over you.  It's kind of like when you make bad relationship choices and you keep falling in love with manipulative assholes- eventually you put up a wall and you distrust almost everyone because you're so tired of being lied to.  It probably sounds really weird and co-dependent to talk about it that way, but we're supposed to be giving our all to these patients.  Some of us really do, or at least did at some point.  When you realize you gave a piece of your soul to someone who was playing you, it really does wound you.
So we compensate and build defense mechanisms.  We say mean things about the people who have hurt us.  We make fun of the approaches they use to try and play us.  We learn to disbelieve people, not only to protect ourselves, put to learn to prioritize and do our jobs safely.  We pride ourselves on seeing through it all, even if maybe we shouldn't feel that way.  We do this publicly, on our anonymous blogs and forums.  And people find it disturbing and gross.
Why wouldn't they? Yeah, some people outside of this profession can put themselves in our shoes or are close enough to someone in the profession to understand.  But the vast majority of people who see it from the outside think we are just bad apples in a profession full of mini Florence Nightingales.  Again, why wouldn't they? In a lot of ways, we in the nursing profession have done this to ourselves.  I remember them talking about this in nursing school.  How proudly they taught us about how we were the most trusted profession in the U.S., year after year.  They even sort of alluded to the massive PR machine that is the nursing profession as it is represented by various nursing organizations when they talked about nurses seeing the show Nightingales and being like, "this makes us look like whores, shut it down, y'all".  And they made it happen.  It's not an accident that the public expects us to be blameless, holy creatures.  We, as a profession, perpetuate this stereotype ourselves.  We not only sell it to the public, we sell it to ourselves and our young.
They don't teach you to expect the type of awful feelings we sometimes have in nursing school.  They tell you about the hurt and loss of having a patient die, but they never tell you about the hurt and loss you feel within yourself when you commit yourself to helping someone that you later realize was manipulating you.  They never tell you that somedays you'll be so tired of doing what you're doing that the thought of going to work makes you feel like crying or makes you nauseous.  They never tell you about being lied to, or how much that sucks, and they never tell you about the guilt you'll feel when you think someone was lying and it turns out you were wrong. They talk about burnout in passing, like it's something you can stop and change.  Like it's a completely internal force.  Like it's a storm you can pass through unchanged, when in reality you come out of it a little tougher, for better and for worse.
I hope this doesn't come across as a pity party or that I'm making excuses for myself or my profession.  I'm still absolutely freaking in love with what I do and it makes me physically ill to think about what I will do the day that I can't go to work and make sick people smile and make anxious people calm.  Despite the parts that I hate, I love the parts that I love so dearly that I would brave just about any amount of bullshit to still be able to do it.  When I question whether it's worth doing what I do, the answer is always a resounding "yes"- I just wish that someone had told me I was going to be asking myself that question.
We already have such a difficult job.  Why do we torture ourselves with setting our expectations and standards beyond anything any of us can obtain? Why do we teach those we'll be taking care of to expect the same from us? Why do we set ourselves up to be disappointed in ourselves, and others to be disappointed in us?
We are not angels or saints.  We are women and men who do a really tough ass job to the best of our ability.  It's about time to start matching our expectations up with reality.

34 comments:

  1. THANK YOU!! As a brand new nurse, I am definitely struggling with all of these feelings. After working my first night shift this past week, I came home crying to my husband because nursing is definitely not what I thought it was going to be. I knew it would be a difficult job, but I didn't realize just how disheartening and sad it can be. I decided to be a nurse because I love making sick people feel better, but this is not what I signed up for in nursing school. I wish they told you in nursing school what to REALLY expect.

    ReplyDelete
  2. Amen! I absolutely agree with your whole post. Nursing can be a very thankless job, especially with all the "entitlement" feelings that people (patients) have.

    ReplyDelete
  3. The feelings you are having are normal. We all go through this, have gone through this. Here's the thing: As a nurse you have to develop a tough exterior. If you don't it will kill you. You just do your job with those who are mean and appreciate those who aren't.

    As far as the profession itself, perhaps this is cynical (I know its hard to believe I would be cynical), but I don't see the profession changing. Ninety nine percent of those attracted to nursing are not going to stand up and change it. Unforntunately. Nursing is a field filled with people who won't stand up for themselves. Its still an honorable profession, one you can feel good about being a part of. You just have to accept it for what it is and figure out if the good outweighs the bad.

    ReplyDelete
  4. Hear, hear, hear! Good for you for realizing these feelings are just feelings and moving on.

    I have been reading your blog for a long time now and you are one of those wonderful nurses who do a thankless job with her whole heart and soul.And, I for one (though I have never been under your care) thank you.

    A very retired RN.

    ReplyDelete
  5. Thank you. You have said this very well. I have been nursing for 20 years and have felt exactly the same way, but have not been able to verbalize it this way.
    I do love my job, just not every single part of it.

    ReplyDelete
  6. Great post! Nurses have one of the hardest and most thankless jobs, and knowing that nurses support each other helps!

    ReplyDelete
  7. This comment has been removed by the author.

    ReplyDelete
  8. I've been reading your blog for some weeks now and this post really made me think. I hope it's okay if I share something.

    My late mother was a registered nurse. If she were alive today, she would be 86. She graduated from nursing school in 1947, back when you learned nursing in a hospital for three years. Most of her career she worked in emergency rooms, just like you.

    She spoke very little about her work at home except to tell my brothers they could beg all they wanted, they would NEVER be permitted to own a skateboard or a motorcycle as long as they lived under her roof. LOL She was a good nurse although she had to retire in her late 40s from full time hospital work because of poor health (heart problems). She kept her "hand in" as a school nurse and in volunteer capacities like church health fairs and stuff like that.

    A few weeks before she died, when she was in hospice care, I was able to spend some time with her. She told me all about how much change she had seen in her profession, both during the 25 or 30 years she worked full time and in the years since that she had been a patient. And she told me that the hardest part of nursing was helping people who she knew would just go out and mess themselves up again--like the guys on motorcycles who woke up in the ER wanting to know if the bike was totaled. LOL

    I know it's not much, but I thought I'd encourage you. Things haven't changed all that much, but you sound like the kind of good nurse my mom was, and I really enjoy your blog.

    ReplyDelete
  9. Not only might we secretly work at the same hospital, but we might also somehow be the same person. A bending of the space time continuum somehow, I'm sure.

    But seriously...well said. I too can only hope that one day the public expectation of nursing matches the reality of what we can do, and that we don't lose any of our soul in the process of dealing with the BS that still comes with the job.

    ReplyDelete
  10. Great post! So true! I think we need a "Nurses are human too" campaign! If only society could realize that, and the profession could admit it to themselves....

    ReplyDelete
  11. Wow! So incredibly well said. Thank you!

    ReplyDelete
  12. When I was a student in clinicals I once overheard one of the staff nurses referring to her patient as an asshole. My sensitive little SN self was hoooorrifically offended, and I took my hurt feelings to post-conference and my fellow students and instructor all agreed that yes that must have been a truly horrible nurse to say such a truly horrible thing. Yeah. Nursing school does not prepare you for real nursing in so so many ways. But you're right, one of the biggest shocks is really the lack of emotional preparation-- in nursing school it's all kittens and rainbows and lovefests. And real nursing is, well, not.

    ReplyDelete
  13. NNITH, I am a malpractice attorney, currently in my 32nd year of practice defending nurses, doctors, EMTs, techs of all descriptions, etc., etc. I've represented hundreds of nurses, ranging from those with 40+ years' experience to new grads and even students. Their attitudes toward their profession range from starry-eyed idealism to total burn-out (and it is not always a function of how long they have been in practice). No matter how cynical or jaded they may have become, however, they still get up and go to work every day with the intention of doing good for others. They fully expect that some other person, usually a stranger, will be healthier, more comfortable, less anxious, more fully informed, in some way better off as a result of their efforts, whether or not that person's actions or attitudes appear "deserving" of such care and attention. This is the main reason I consider it a privilege and a pleasure to represent the many nurses I have defended.

    I am sorry to see you beat yourself up over the fact that your emotions and internal dialogue do not always match your ideal of nursing practice. The success of nursing PR has set an unrealistic standard, and of course none of us ever lives up to our aspirations perfectly. My free advice (worth exactly what it costs) is to continue to give the best nursing care you know how to provide and give yourself a break on the impossibly high expectations.

    ReplyDelete
  14. This comment has been removed by the author.

    ReplyDelete
  15. As hard as it is to work with ill infants, I chose NICU nursing in part because my patients are NOT entitled assholes - or at least aren't able to express it yet. :) However, we have plenty of families who are jerks, and a myriad of nightmare social situations (including many which caused my patients' prematurity or drug withdrawal etc.). In my brief time as a nurse I have lost SO much faith in humanity and feel myself becoming ever more cynical. It helps to have a full and active non-nursing life, and I find myself recharged by every nice family that I work with and every healthy baby that returns to visit.

    Ultimately, though, even though nurses are viewed as one of the most trusted professionals, I think it's very helpful and healthy for the general public to know that we are NOT angels. Though many of us are called to nursing by a desire to help people get well, the majority of us are also realistic about it being a JOB and are only willing to put up with so much bullshit in order to get a paycheck.

    ReplyDelete
  16. It's great when a supervisor is not Pollyanna.

    ReplyDelete
  17. I had that thought when I was at Hood Hospital. A lot. It was pretty sick the way I wanted to hurt the patients. Literally either choke them, punch them, or push 2 gm of succh and walk out.

    I can tell you this....its bc you are at hood hospital taking care of trolls. The grass is greener on the other side.

    Miss you

    ER Doc

    ReplyDelete
    Replies
    1. Ugh. I really need to get out of here and find another job. The prospect of leaving my coworkers ultimately keeps me coming back to this nonsense constantly. Maybe NP school will save me? Also, imma need you to coordinate your schedule with mine better in the future.

      Delete
    2. hoodnurse: Your skills that you have aquired will be sought after by many hospitals. There are jobs out there with less foolishness. It won't disappear entirely...but not quite what you deal with now...

      Delete
  18. NP school sort of helps. You get a lot of starry eyed crap but get some realness with clinicals. But beware the acadamia setting. I got in trouble because someone didn't like the conversation they overheard so I got called in to discuss how teamwork BS was important yadda yadda. . .

    ReplyDelete
  19. Thank you so much for being courageous enough to actually say this out loud. How many times have I felt this way and beaten myself up about it. Having overwhelming feelings of rage towards patients and then being shocked that i could feel such hate towards sick people. I would feel like a fraud, like a really shouldn't be a nurse. A "real nurse" would never feel this way. But we do feel this way. We are not saints, we are humans. This is a topic i have felt often but never ever heard someone talk about. THank you, thank you, thank you!

    ReplyDelete
  20. The problem is that people use the ER as a one-stop-shopping for whatever, many of which is not related to actual acute illness. Sort of like Wal-Mart for people with social/economic/substance/mental health issues. No one is appreciative. Rarely do you even get a "thank you".

    ReplyDelete
    Replies
    1. I wanted to say also that I love reading your blog too. My mom would have loved it as well, I'll bet. She had a sense of humor too. :)

      Delete
  21. I work with at risk children and... their parents. I think I read this blog because it is the only thing I can imagine that one ups the insanity and foolishness level of my job. I love my job, and I earnestly care for the kids and want to continue pouring myself out into helping them (for a ridiculously low wage) but sometimes after you face a ridiculous circumstance (kid goes crazy and runs out of the building into on coming traffic and you have to bodily wrestle them to safety) you have to blow off steam. Sometimes that means inappropriate humor with coworkers. If outsiders heard certain conversations they might think we were callous, but really... it is what you do to keep going on.

    ReplyDelete
  22. From an ER nurse to another ER nurse.... Bravo! You said what we feel but no one will admit. It's brutal to care for seekers, homeless or the rich student who yells "This is primary care, you should check on me every 30 min." (He had a cold.) Thank you!

    ReplyDelete
  23. What's worse than feeling this way several years into nursing....is to feel this way 35 years into nursing without the benefit of a forum where it can be expressed or discussed.

    It's been 35 years of torture for me - you voiced my inner thoughts exactly....and of course, beat myself up over it....a heaping load of guilt.

    It's gotten to the point where I don't like nursing at all...but I still do it, and people tell me it LOOKS like and SOUNDS like I care.....but I really don't. Not anymore.

    Well, ok. Once in a while there is a dear sweet elderly person that I would love to take home with me. Or a brand new mommy with breastfeeding problems that I would love to sit with for a few hours and help out.

    It's a conundrum. I fight it every day I work....can't wait for the peace of retirement.

    ReplyDelete
  24. from one hood hospital ER nurse to another... thanks girl! this is great. people can be huge assholes. the thing i just try to remind myself is what they DON'T need: 1) syrupy sweet niceness (that's obviously fake) from someone trying to be a "good nurse" or 2) a total asshole nurse who's judging them up one side and down the other. seems like the more frank and honest we are the better it goes. always a challenge though!

    ReplyDelete
  25. I know approximately nothing about medicine and I've never been put off by anything a nursing blogger has said about patients. Of COURSE you want to hurt them sometimes! Who wouldn't? Most of us can barely deal with ONE obnoxious, insulting, needy liar at a time.

    I have no doubt that you still do your job, which is all that matters. Your thoughts and feelings are your own, and you have a right to them. Please don't be ashamed.

    ReplyDelete
  26. You've got a great way of expressing yourself and talking about the profession. So, I sincerely hope you don't totally lose your license and/or your job for coming incredibly close to breaching confidentiality the way you do, often. Good luck.

    ReplyDelete
  27. This could not have been said better!! Thank you...this is a huge reason that I no longer do hospital nursing and why I never really enjoyed it. I got into home health in more of a specialized area and I am very happy to say that I don't have those kind of thoughts anymore. I truly love what I do and I actually get respect from my patients and that brings me much joy and makes me love going to work every day!! Just remember that the thoughts and feelings are completely normal because people these days take advantage of good hearted people, but at the end of the day as long as you don't act on them and still enjoy doing what your doing then keep doing it. This blog is well said and I agree that nursing scholar definitely should have prepared us for some of the other crap that we would have to deal with!!

    ReplyDelete
  28. My fiance found your blog and posted it on my facebook. I finally read it about a week after he posted it and I was disappointed that I hadn't read it sooner.

    I feel your anguish and frustration with nursing and patients. It is not the idealistic profession that everyone thinks that it is. I agree with you 100% and your view...I too am an ER nurse amongst a few other things. I almost left nursing all together a couple years ago because I was so burnt out on the people that took my joy of nursing away. I was bitter, I had that dreadful feeling with the lump in my throat everytime I had to get ready for work. My anxiety level was crazy out of control and I thought that I had made the biggest mistake of becoming a nurse.

    "I should have been a doctor," I kept telling myself....Thankfully God must of heard my cry because he gave me a job that I love (most of the time). I remember the relief that I felt when I knew I could leave the hell hole that I was in and move into a mindfully peaceful job. I have some crazy ass stories to share...I think blogging is good for me, nursing is a world of its own..bring it!

    ReplyDelete
  29. I've just started reading your blog. I'm a teacher switching careers to nursing, hoping to start school in Jan. It's not just nursing. Teachers are treated the same exact way. We're supposed to love educating the future but then feel bad when we don't. I've just had one of the worst years of teaching ever, was cursed at multiple times, had kids walk out of class, was accused of hitting a student (I tapped their shoulder), and also for the first time actually had to grip my desk to keep my hands from reaching out and smacking a student. I know how you feel. It's not just nursing, but I appreciate the reality check, I'll keep it in mind when I start nursing school.

    ReplyDelete
    Replies
    1. A good friend of mine is making the same switch, and my husband is a teacher as well. In my opinion, what you guys do actually requires more patience. In my field there is at least some responsibility and some expectations when it comes to the students. From what I gather from my friends that teach and from my husband, it seems like the blame is placed solely on the teachers regardless of whether the kids want to learn or not. I think in nursing you get a little more leeway to tell people what's what and a little more gratitude depending on where you work.
      The bottom line is people are a lot of the times just incapable of acting in a civil manner. We just have to put our heads down sometimes and learn not to take it to heart. It sucks, but it's doable.

      Delete
  30. This was exactly what I needed to see. I'm in the middle of nursing school right now, and at 4am on a Friday night, I'm unable to sleep due to stress. I googled unrealistic expectations of nursing students and found your blog. You hit the nail on the head regarding the things they don't teach us in school. I could go on for hours about how right you are in every point you made, but I'll leave it at this: wherever you are, please become a nursing school instructor. We need more nurses like you educating us.

    ReplyDelete