In the first year of my career as a Registered Nurse I continued my education, wrapping up my Bachelor’s Degree in Nursing, not yet a requirement to work as an RN, but a well worth it continuation of a degree to make you a more well-rounded, and to be honest, respected Nurse. One of the requirements for this degree was a course called “Professional Issues and Trends”. The course explored the profession of nursing, barriers it is facing, and the way that we, as nurses, can change that. I learned many things in that course, but the most important, the thing that has stuck with me the most was this.
A few days into the course, our Professor made one thing very clear; each and every one of us, from that moment on, needed to remove “Just a Nurse” from our vocabulary.
“Are you a Doctor?”
“No, I’m just a nurse.”
I have spent six years since trying to avoid that phrase. More so, I have worked to avoid that feeling. I work hard at what I do, but am often aware that my friends and family have no concept of what nursing is. I don’t bring you to your room at the doctor’s office, sit you on the table, and check your normal blood pressure, then go and get the Doctor. Instead, I am often in a room with a small child on a ventilator, multiple intravenous medications infusing through central lines keeping the vascular system constricted or dilated. I monitor blood gases and adjust ventilator settings accordingly. If the blood pressure goes too high I adjust the medications related to these values. I keep my patient adequately sedated and paralyzed, for their safety, without over medicating them. It is often my responsibility to determine this balance.
Recently, I had a nearly two year old patient who pulled his own breathing tube out in the early morning. We weren’t sure whether he would do ok without it so I monitored his respiratory status closely all morning. By mid-afternoon he seemed to be doing well enough. By then his sedation had worn off and he had no interest in staying in bed. Concerned that he would harm himself moving around through multiple IV and arterial lines, plus a BiPap machine, and monitor leads, I decided to hold him. He had no family present but needed close to a dozen IV medications over the next five hours. I collected them all and lined them on his bed. I pulled his syringe pump that would be used for the medications off of the IV pole and placed it on the bed in front of me. I lifted him out of bed and onto my lap, into my arms. For five hours we rocked and I held him close. He stared into my eyes, played with my hair with his one arm, tried to suck this thumb through IV sites and arm boards. I gave his medications one by one until the nurse who would relieve me for the oncoming shift came in.
I’m not just a nurse. I am a nurse. I can over the course of the 12 hours shift go from interpreting serial blood gases to comforting a sick child while continuing to monitor vital signs, respiratory status, and administer medications.
I am the eyes, hands, and feet of the physician. I am not their eye candy, or their inferior. I don’t stand up when they enter to room. I don’t follow their orders, I discuss the pathophysiology of the patient’s condition with them and together we make a plan. Often the things I suggest are the course of action we take, other times I learn something new I had not understood from this doctor. They don’t talk down to me, we discuss things together.
I had an experience this weekend, one of the first of its kind for me, and I was surprised by how angry and affected by it I was.
A friend cut their arm and hours later still struggled to stop the bleeding. I assessed the wound and created a pressure dressing out of the supplies you have available in a Frat house cottage. I reluctantly informed the friend that the wound would likely need a stitch, or glue. It wasn’t large, but was deep and wide and would likely heal poorly, if at all, and even if it didn’t become infected, would leave a decent scar. I am not one to jump to big medical interventions, if anything I ride the line of noncompliant and under concerned.
My opinion was shared but another guest, a doctor, decided it would probably be fine with a Bandaid and heal without issues. He may be right, or I may be right. But a close family friend who I have known almost my entire life chimed in,
“No offense Kateri” he said, “But obviously we’re going with the doctor over the nurse for this one.”
“You’re just a nurse” he might as well have said, although he didn’t.
I felt like I had been smacked in the back by a two by four. Another friend present knew this would be my reaction and turned in horror as the color left my face and the posture left my shoulders. Something inside of me sunk.
The following day I struggled to understand why I was still upset. Surely he had no idea what his words had meant, or how they felt. But over lunch the following day, as I discussed my new job with my family, it became clear. My job is so much, and so much of it is misunderstood. And maybe this is no one’s fault but my own. Sure I’m a nurse, yup some days are sad, yeah, blood and poop don’t bother me.
But that’s all I say. I don’t tell you what I really do. And the media definitely doesn’t either. Nurse friends, help me out here. Maybe it’s time that we stop pretending we are less than we are, that we do less than we do.
I came across the following blurb this morning. I wrote it a few years ago for Nurse’s Day, and it rings as true today as it did then. I may not be a doctor, but I am a nurse. And if you are someone whose mind says “just a nurse” please, go ahead and ask the nurse you know best what it is that they do. I think you may be surprised.
I am a Nurse. I didn’t become a nurse because I couldn’t cut it in med school, or failed organic chemistry, but rather because I chose this. I work to maintain my patient’s dignity through intimate moments, difficult long term decisions, and heartbreaking situations. I share in the joy of newly born babies and miraculously cured diseases. I share in the heart break of a child taken too soon, a disease too powerful, a life changed forever. My patient is often an entire family. I assess and advocate. Sometimes I wipe bottoms, often I give meds, but that isn’t the extent of what I do. There are people above me, and people below. I work closely with both, without them, I could not do what I do well. I chose this profession and love almost every minute of it. I know I am not alone and I appreciate all of the nurses who work alongside me. Many of them have shaped me into the nurse I am. Someday I will shape others into the nurse they will be. This wasn’t my plan B, it was my plan A, and I would gladly choose it again.