Posted by: PD Warrior | September 9, 2007

Oh the (In)Humanity Of It All

The work clothes are in a rumpled pile in the basement, and the cellphone has been turned off; it’s time to break out with the cheese – because I’m about to have a little w(h)ine…

I have been an RN for over ten years. It’s a profession which I truly love, and would not trade for the world. Let’s take it one step further; specifically I am the ADON (Assistant Director Of Nurses) at a Long Term Care SNF (Skilled Nursing Facility.) Basically that’s a fancy way of saying I’m third in command at a nursing home, after the Administrator and the Director Of Nurses – a position which I worked long and hard to obtain.

I have learned through out the years that the general public pretty much lumps nurses into one of two categories; they are either Angels or Demons depending on the disposition of the patient/loved one at the time. In my position I have learned to step back from situations and try to look at things from the viewpoints of both the patient and the nurse, and I certainly understand how/why we are looked at this way. Angels, because we offer compassion and relief in a person’s time of need, and Demons because we prevent the patient from doing something that may be detremental to their own health or perhaps make them do something they don’t really want to do – again for their own health. As for me, depending on what the situation calls for, I am capable of wearing both Halo and Horns equally as well.

What people don’t realize is what goes on behind the scenes – everything that goes into being a nurse.

  • Education – Nursing school is grueling at best. It has to be in order to weed the ones who “can’t hack it.” As nurses we deal with tough situations and need to make snap decisions every day; decisions that ultimately make the difference between life and death. The grading system for nursing classes is entirely different from those of regular classes. In the school I graduated from the grading policy was as follows: To receive an A you needed to maintain an average of 98-100%, a B+…95-97, a B…90-94, a C+…97-89, a C…82-88%. Anything below a “C” average was failing. This doesn’t even take int account the physical stress of long clinical practice hours. And the learning doesn’t stop after graduation. Nurses must keep up with the standards of practice that change on an almst daily basis.
  • Doctors (part I) – believe it or not, doctors can and do make mistakes. As nurses we must catch these mistakes and bring them to the MD’s attention for clarification – we are held legally accountable for this, and to say we didn’t realize something was a mistake, or to do something on the premis of “the doctor ordered it, so it must be okay” just doesn’t fly. Depending on the personality of the doctor, challenging their order is not always an easy task.
  • Doctors (part II) – doctors rely heavily on nursing judgement. Let’s face it, as nurses we spend much more quality time with the patients than doctors do, and to their credit, most doctors realize this. They take us at our word, and in many cases will even ask our opinion on what should be done. Of course, by now they probably realize that most of us nurses are pretty strong willed and we are going to give them our opinion whether they want it or not… 🙂
  • Doctors (part III) – this actually ties in to Doctors (part I) … if we find a mistake a doctor has made in the orders given for a patient, and we have called to notify the doctor, and the doctor still insits on leaving the order as it is… we as nurses must assess the situation – if we still feel we are right then it is our legal (and moral) obligation to defy the order, and take it to a higher source (yes, even doctors have bosses, though they hate to be reminded of that)
  • Things we have seen and done – anyone who thinks nursing is a glamorous job is dead wrong. It is a dirty job. We clean beds, we clean clothes, we scrub bed pans, emesis basins and various other pieces of medical equipment that you don’t want to know about, but most of all we are “Janitor’s of the Human Body” and as such we have put our hands in places that hands were never meant to go. We deal with sights, smells and sounds of things that most people cannot imagine. For the first couple of years that I spent as a nurse I used to say “now I have seen everything” when dealing with new and unique situations. I have stopped saying that, because I know full well that tomorrow I will see something even stranger than what I saw today.
  • We don’t just take care of the patient. Some times we spend just as much (possibly more) time with the family, listening, comforting, educating, whatever it takes to see them through their situation. Often times we get verbally abused and even threatened with bodily harm.
  • We cry – sometimes in public, sometimes behind closed doors, but we do cry. We feel the patients pain, we feel the families pain. We feel the angst when we know things will get worse and there is absolutely nothing we can do about it. We feel the frustration of knowing that something is wrong, something is making the patient feel/act they way they are but all the tests are coming back negative and we “just can’t put our finger on it.” We watch as we do everything we can to keep a terminally ill patient alive, prolonging their pain and suffering because family members are going through their own pain and suffering and are not able to “let go.”
  • We laugh – nothing beats the feeling of seeing the sparkle in a patients eye as they tell you a joke, or give you a hug when you have done something to make a difference for them.
  • We grieve – The first thing they tell you in nursing school is “don’t get attached.” It’s a nice thought in theory, but one that is almost impossible to do. As nurses we do learn to harden a certain part of ourselves. Dealing with death on a daily basis we wouldn’t be able to survive if we didn’t, but in the facility I work in, the reality is this: For most of us -especially the ones on the “front line” doing the hands on care – the people we take care of become partof our family. We get to know them inside and out. We get to know their family members, and every little thing about their family dynamics; the things they did in the past, the things they didn’t get to do but wanted to, and the things they still dream about doing. You can try all you want to harden yourself and not get attached, and over time it does become easier to do so, but some patients just wont let you do so. Some patients by their very personalities demand to be let into your heart, and you are powerless to stop them.
  • Some days we just want to go home – the job is stressfull, and like any other job, some days are worse than others. I am honored to work with the nurses employed by my facility. Each and every person I work with goes above and beyond every second of every minute they are there, and at the end of the day we are drained but we all leave wearing the same mask we have worn all day long because because we know that somewhere, either in the parking lot, or the grocery store we stop at on the way home, we will run into someone that knows us. Someone will invariably come up to us and ask “how’s my mother today?” (even though by law we are not allowed to discuss patients outside the work place) or “I remember you, you’re the one that took care of my dad when he was sick…”

Angels and Demons. As nurses we are both, and by both we are haunted… I would not trade it for the world, I just ask that you understand we are also humans that have been called upon to wear both Halo’s and Horns and the world we live in is neither Heaven nor Hell, but exists solely on the fine gray line between the two.

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  1. I don’t think that was a whine at all, but a clear expression of your viewpoint. As a longtime caregiver, I have dealt with my share of Demons, and plenty of Angels. I have never minded nurses who had to do the hard thing for the patient’s own good, as you characterize Demons. My problem was always with the nurse who had too successfully hardened themselves, and for whom it was just a job. Thank goodness, those kind are in the minority.

    The biggest problem I see is that they are spread just too thin, with way too many patients to take care of. Instead of dealing with nurses, most of the time we deal with PA’s!


  2. I’m glad you didn’t find this post too whiney, because I was just a wee bit over stressed when I wrote it. Thanks for reading, and for understanding.


  3. Hi PD (Joe), This is Cathy. I have been getting the 9/11 stories ready and realized I haven’t yet received yours. I hope you still send it to me today. I really enjoy your posts and I think you would write a really good post for this horrible topic.

    Please send me an email and let me know. Take care of you!



  4. I didn’t think it was too much either. Rather, it’s an honest reminder to all of us who aren’t nurses, just how valuable you are. I worked at a senior center where I let myself get attached to our members. I’m not sorry, but everyone became “my” mother or “my” father. It was sad at times but not so much that I wouldn’t do it again. DB is right about the overly hardened of your profession, but I can’t blame them too much. You have a tough, tough job.

    Thank you for being there.


  5. Thank you for this post, PD. I am sending a link to it, to friends of mine who looked after my mother during her last months. They were Angels, even when they were required to be Demons.

    Both faces were only wonderful, in my eyes.


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