Q: What do you call a nurse with a bad back?

I love nurse Jackie. It's probably not good to advertise this, but in some aspects she's a very realistic nurse. She's probably got a little bigger dose of crazy than the average nurse for entertainment's sake, but if you divide her oddities up and distribute them among a handful of nurses, you probably have it about right.
(The answer by the way is Unemployed.)
I always thought nursing could benefit from a really good realistic show. Shows like House, and ER really haven't been helping us much. In ER the nurses are occasionally visible, but always on their way to med school it seems. In House they're pretty much nonexistent.
Don't even get me started on HawthoRNe...that show is just an embarrassment to us all.
Actually, let me get started on HawthoRNe for a second, because I really feel like the non-nursing public needs to know how we feel about this one. For those of you not familiar, HawthoRNe is a relatively new show on TNT staring Jada Pinkett Smith as some sort of head nurse. Why the head nurse for the whole hospital is involved in patient care and hanging around the ER all day is beyond me, but that's the least of this show's problems.
HawthoRNe has a few of the usual (and somewhat forgivable) hospital show problems. For one, the boundaries of the different areas of the hospital are fluid. Nurses, doctors, and whoever, are easily moved from one part of the hospital to another depending on the plot needs. This often results in a nurse working in the ER one day and on a regular hospital floor caring for the same patient the next day as the plot requires. This wouldn't happen. Number two is that they really don't stick to the realistic abilities of your average community hospital. Obviously the hospital is somewhat small in HawthoRNe, but that doesn't stop them from participating in the sorts of treatments you'd see in your large, research facilities.
But I'll let those slide. There are a few unforgivable sins committed by HawthoRNe however, that the nursing community will not, and the public should not, allow to occur in nursing-based TV shows (or other media, for that matter.) This list is not necessarily in order of importance. Also be aware that my critique is limited to season 1 (if God-forbid, there are more seasons down the road, I want to make that point clear.) This is obviously because I couldn't stand watching any more of it. I'm not entirely sure how I watched as many episodes as I did.

Unforgivable Sin #1: The male nurse is a joke. There's only one on HawthoRNe, and he's embarrassing to male nurses everywhere. The only thing he has going for him is that he's straight, and therefore breaks the often-held stereotype of the gay male nurse (although I'd take Nurse Jackie's ultra-gay male nurse Mo-Mo any day over this moron.) He's an incompetent, weak, Dr-wannabe. He spends his days drooling over the slutty nurse on his unit, despite her flaws (which we'll get to next.) The writers lose no chance to make him look ridiculous. On the few times that they do allow him to have a bright idea, it's squashed by his complete lack of a pair of testicles.
I'm going to be truthful here. I've known many male nurses. They tend to accumulate in the type of nursing that I work in, which is highly skilled and intense, and so I've had the pleasure of working with many of them. They are none of the things that HawthoRNe makes them out to be. They are masculine, they are straight, gay, all different colors. They are fresh out of college, and they are the 50 year old with 3 teenage kids. They are highly intelligent and very emotionally in tune with the world around them. Contrary to public opinion they are all types of men, none of the types being stupid. Also, and listen very carefully to this one, they got into nursing to be NURSES, not because they couldn't become a doctor, the education is not interchangeable. You do not get to be a nurse automatically because you went to med school and failed. Congrats HawthoRNe, they weren't having enough problems being a male nurse, it's a good thing you made the label a little more embarrassing.

Unforgivable Sin #2: The Slut.
This actually may be the most important unforgivable sin of HawthoRNe, I couldn't decide (which is why I decided not to order them by importance.) This ridiculous specimen of nursing is who male nurse has chosen to be in love with, despite her flaws. It's a big flaw too...(cover your kids eyes for this one...) she gives certain sexual favors to patients. Mainly patients who served in some branch of the armed forces. Apparently she does this often enough that in one episode, a young man comes into the ER and requests her specifically. This prompts a warning from idiotic male nurse that perhaps this isn't a good idea, and she would get in trouble if people found out. Yeah, that's right. Not a completely normal reaction like ICK ICK ICK ICK ICK OMG ICK!!! He simply says "you shouldn't do that anymore...but ya you're still hot, so I'd still do you." OK, so that's not exactly what he says, but that is the gist of it.
This has a couple of problems. First of all, as a young cute nurse, I get hit on fairly often. This ranges from the completely innocent grandpa telling me that I'm cute to skeezy guy asking me for favors of a sexual nature. Nursing in general has not been served by the naughty nurse costumes of the last 100 years or so, and almost every nurse gets hit on. To be honest, age and attractiveness don't matter much. This drives us all crazy. If you say something uncomfortable to us when we first meet you, we have to continue to interact with you for another 12 hours....not cool. This episode perpetuates this discomfort x10, into infinity.
The second problem is that this has NEVER happened. Sorry guys, didn't mean to crush your hopes, but no actual FEMALE health care worker with college education has ever done this. EVER. I could tolerate unfavorable views of nurses if they were realistic, but this is not. It's icky. I'm sorry to all you male patients out there once again, but when you're in that hospital bed, you're not really seen as a fully functioning human being with us. Your penis isn't really noted as a penis, just another appendage of you. We kind of think of you as children that need our care. You are not viewed in a sexual capacity at all. That would be, well, icky.
To summarize. Nursing has enough working against us, what with the costumes mentioned above and with half the porn in existence. You could make the chicken and egg argument with this one, and we could go round and round trying to decide if that's a symptom or a cause, but at the end of the day it doesn't need to be perpetuated by a show that isn't supposed to be sexual in nature.

Unforgivable Sin #3
The show is just stupid. OK, maybe we could have gotten this out of the way early, but it's one of the show's smaller problems, so it gets to be #3. The writing is terrible, the plot unbelievable, and the acting causes more eye rolling than praise. This really doesn't have much to do with the nursing aspects of the show, but its unforgivable just the same.

"You people don't have a clue"

I always enjoy meeting my patients for the first time, especially after I've been taking care of them for awhile. That, on face value, may not sound like it makes sense. Many of my patients, however, spend their first many days unconscious and on a ventilator, so in a sense, I haven't really met them. Sometimes I never get to meet them. On many occasions I've taken care of someone for 3 nights in a row, and then my work week is over. I leave for 2 or 3 days (sometimes 4 or 5) and when I come back, the patient has either died or been discharged to the regular hospital floor. Many times I've told myself that I'll go out to their new hospital room and say hi...but I never have. I always think that it's a little creepy that I've been taking care of their most intimate needs and they don't even know me. They couldn't pick me out of a line up. I think if I was in their place, I would feel that way. I'm sure they would not, but I don't go and visit, anyway.
Not on this night though. On this night, I took care of this guy all night. In the morning, the doctors asked me to wake him up and get him ready for extubation, so I turned off the sedation. This apparently did not please him. Shortly thereafter he began gesturing wildly at me, and slamming his fist into the side of the bed.
"What!?" I exclaimed, "Are you in pain?"
He shook his head "no."
"Do you know where you are?" Sometimes confusion can lead to a lot of pre-extubation stress.
He shook his head "yes" and began wildly gesturing at the air again.
"I have no idea what you're trying to tell me," I said, "Calm down and I'll find you some paper."
I return almost instantly with some paper from the printer, a clipboard, and a marker (often people on ventilators don't press hard enough to use pens...I'm not sure why this is, but it's a universal fact, ask any nurse.)
I begin giving report to the next nurse while he writes his all-important message on the paper. When done, he tosses the sharpie at me.
"You people don't have a clue," I read aloud. I raise an eyebrow, "That's neither useful nor helpful." I told him. He begins angrily gesturing again, so I give him back his flung sharpie and the paper. This time he writes something else...but I can't make out most of it (the other universal truth among nurses is that being on a ventilator gives you crappy hand writing.)
"Have fun with this one," I tell the next nurse.
"You should have left him sedated," he said. "Some people are just too mean to be conscious."
Ok, so they're all not so much fun to meet.
The other thing I love is sharing a happy moment in their lives with them. That one is pretty rare. Just by meeting me, it's likely the most unhappy time in their lives. The one exception is our 1A heart transplant patients. 1A means top of the list, sickest of the sick needing hearts. The reality is that 1A doesn't necessarily mean number one on the list. There's another transplant center less than 30 minutes away who probably also has a few 1A patients, as well as many other transplant centers within radius. Add that to the lack of donors, some patients sit on our ICU and wait a long time. They aren't as sick as a lot of our patients (usually.) They're well enough to get out of bed and sit in a chair, go for short trips outside (on a monitor and accompanied by at least one RN and another health-care worker), and they're definately well enough to miss being able to take a shower.
A few nights ago, we hear the rumor that there's a 20 year old in the Neuro ICU that has been pronounced dead after a closed head injury, and his blood type is a match to one of our patients. This is usually how the sequence of events leading up to a transplant begins...with a rumor. The organ donation people are very secretive. They don't want anyone knowing anything until they themselves are absolutely sure. This process involves first obtaining permission from the family to harvest the donors organs. Since the patient is still on life support, they can take days. This is especially true when the particularly young die, or when the family dynamics are dysfunctional.

Then the donor is tested for...well, pretty much everything. These tests can take hours. Very rarely is the heart considered good enough to be a donor heart. You would think that for these patients ANY heart is better than what they have, and this is probably true, but heart transplant surgery is no walk in the park. The heart has to be strong enough to survive the insult of being pulled out of one person, stored in a cooler (often for a few hours) and then put into a new body which isn't always welcoming. The immune system begins to attack the new heart almost immediately. We give the patients drugs to slow it down, but it's very difficult to completely stop the process. The best hearts are young and large. Teenage/young 20's boys make the perfect donors.

Once the heart is found to be of high enough quality for transplantation, the organ donor people step in again. They begin going down the list in an outward circle to figure out who is going to get the heart. Preference is given to distance, and how ill the recipient is. After a certain point, however, a recipient can be considered too ill, making them less likely to get the heart. During this phase, the nurse often gets a phone call, asking about the most recent cardiac numbers on a particular patient. That's often the first clue that a nurse gets that her patient may be getting a heart.
It also starts a flurry of activity. Every nurse has to look at the last waveforms obtained from the patients heart catheter and give his or her opinion. These waveforms have to be interpreted absolutely perfectly. No one wants to make a mistake on a patient's numbers when a new life is on the line. No matter how excited we are, nurses do not reveal to ANYONE what's going on. We do not even tell the doctors on our unit at this point.

Even if your patient is chosen, it's still many hours before it's time for surgery. This process has to be repeated for every other organ being donated. Liver, kidneys, lungs, all have to be removed while the heart still beats. Those recipients have to be identified, notified, and everyone has to be put in place. Helicopters have to be ready to fly the organs out that aren't being transplanted in house, some organ recipients sit at home with pagers, and they have to be brought to the hospital and prepped for surgery as well.

If your patient is chosen, it's pretty much the happiest moment of your life, too. Sometimes the nurse is happier than the patient. That may sound exaggerated, but many patients have emotional issues, and doubts related to getting a heart. They know too well that this heart came at the cost of someone else's life. Probably someone young and vital. Their happiness at their new chance at life, also comes with the dark cloud that someone died for this gift.

For the nurse though, death is familiar. People die all the time, and we know it all too well. Grandmas and Grandpas die, moms and dads die, but so do young adults, teenagers, and even toddlers and babies. Everyone dies. It's easy for us to realize that there was nothing that could be done about the teenager driving off the road into a tree, or the snowmobile accident fueled by alcohol, or the occasional random lotteries that are brain aneurysms. We're just grateful that at least a new life can be lived out of senseless tragedy. We're about 10 steps removed from the process, for us it's an easy thing.

Telling your patient isn't your job. It's the doctors (damn bastards, they get everything!) It is your job however to tag along and then deal with the emotional aftermath. There's going to be screaming and hugging and crying. The more family that happens to be in the room at the time, the more emotion there will be.

Despite all this, we try to keep the whole thing quiet. There's usually more than one patient on the unit awaiting transplant. We do not allow them to know that someone else is getting one. Once or twice it has even happened that two patients on our ICU were being considered for the same heart. It's hard then to walk out of a happy room and into another patients room and pretend like it's just another day of waiting for you, as well.

On this occasion, after my patient had been told and whisked off to the ICU specializing in thoracic surgery to prep for the OR. I sat by myself in the break room. Another patient would fill the empty bed soon enough, but for now I had a chance to sit down. I was contemplating how downstairs the donor was also being prepped for surgery. That part was a little strange. Our hearts usually come from other hospitals, not our own. The donor was always this far off person, not really a person at all. It was strange to think that I could hop on the elevator and go look at them for myself, could meet their grieving family, could hold their hand while it was still warm. The happy crowd that had just poured out of my ICU including the donor, and all of his family, friends and even a few of his doctors was a sharp contrast to the sobbing family that I knew I'd find downstairs. It's strange how much happiness can be born out of tragedy.