Personal Perspective: The Real, ‘Dirty’ Truth About Nursing
(by Ryan Price, RN. Originally published December 2002. Republished and revised © February 2012)
My partner is hospital at the moment. People – family, colleagues and other nurses – assume that because I’m a Nurse, I can deal with how sick he is, and maybe that I don’t need the support a ‘regular’ relative needs. This isn’t true, and when his Nurses catch-on to my profession, they exclaim to me “Oh, you’re a Nurse!” my usual flippant reply is “maybe, but I’m firstly his partner!” It made me think hard about how we are seen as Nurses. Often, even the healthcare profession forget to see the human element behind the facade of uniform. It’s downright terrifying for anyone to be faced with their own mortality, and maybe moreso when faced with the daunting prospect of what may lie ahead for their most precious, dearest loved one.
So, while spending countless hours at his bedside, I allowed myself a few distractions after he finally settled and slept through the most awful fever. On this occasion, Facebook was my distraction. And then I saw it. Again… I have a lot of Facebook friends who are nurses. This means that I see a lot of copied and pasted posts that are along the lines of “Right now, a nurse is being vomited, peed, and poo’d on, while holding her bladder and starving from missed meals, and probably simultaneously holding the hand of a dying patient and explaining procedures to family members and subtly guiding a doctor to order what’s needed and…and…and…(sniff, sniff)…and why is everyone always shouting at us about being late with our medication?!…copy and repost if you are or love a nurse!” I’m a nurse, too, so I think I get where these posts are coming from. It’s a daunting, sometimes even overwhelming, profession, but I can’t bring myself to beg for a pat on the back for it from Facebook, or from anywhere else for that matter. I’m not claiming any moral higher ground here, because truthfully, I also have those thoughts sometimes, and well, that whole thing about begging for people to love me via my blog or Facebook or Twitter (ad infinitum), or even in real life is pretty indisputable. In fact, this whole discussion about whether those posts are somewhat self-congratulatory represents a major digression from the actual point of this opinionated semi-rant, which is the perceptions versus the realities of nursing. Today I encountered one of the aforementioned Facebook posts, and was amused to notice that one of the poster’s (younger, but old enough to know better) male friends had responded with surprise and disgust to the pee/poo/sick portion of it. My first reaction was to wonder what rock that commentator lives under that he was unaware that nurses deal with bodily functions on such a grand scale. Then I started thinking about the questions that non-nurses ask me about nursing.
The Poo Most people seem pretty hung up on faeces. I don’t know why; on a scale of one to repulsive, most of the poo earns a mediocre score, at best. Maybe this is because it’s so ubiquitous – most people are going to poo while they’re sick, and if they don’t, we might give them medicine to help things along. If this fails, some lucky glove-clad nurse will win the opportunity to join the digital age. Many nurses are fixated with bowels. Anyway, unless a poo is exceptionally vile – or ‘offensive’, as we call it in the trade, it’s unlikely to phase most nurses (on a side-note, I always giggle inside when I see ‘offensive diarrhoea’ written in notes or reported on, as I get this mental image of a watery, but really angry turd jumping out and yelling “get-you-bitch-mother” at any unsuspecting nurse! Aaaanyway…). So, when people lead off with the “Soooo…is it hard cleaning up all that poo?” question, I just smile and say, “not really, you get used to it.”
The diagnoses This one starts early. All you need is a day or two at uni after you start nurse training, and suddenly the world is filled with sufferers of angry red rashes and unexplained elbow pain, asking if you could give your expert medical advice. I learned my lesson very early on about keeping quiet about my line of work, shortly after a very elderly lady at a bus-stop asked me what I did. I naively and politely answered (I was taught manners and respect, after all) and before I knew it, she had told me “I’m 92 years old” (I didn’t ask?!) and then after missing 3 busses home after a very long-day in A&E I knew about her hip replacement, that she’s getting the other done with Mr. Weston (“oooo isn’t he lovely? Have you met him?”) and that her husband (“God rest his soul”) had a “spastic colon and it strangled him.” Seriously though, here’s the deal: the nursing scope of practice does not include medical diagnoses. I never attended medical school (though I have watched a lot Casualty/Holby City/Gray’s Anatomy, which means that I am fully qualified to diagnose you with three inaccurate obscure diseases, and then one obscure disease that will turn out to be the correct diagnosis), so the best I can offer you is a forecast of what tests you’re likely to experience when you go to the doctor. I can’t prescribe drugs, so, technically, I can’t even say “that looks painful. Maybe you should take some Ibuprofen,” because, if I do, and then blood shoots out of any of your gastrointestinal orifices, I may be liable for misrepresenting my capacity to recommend treatment. In all actuality, most nurses probably can accurately diagnose a lot of things, based on test results, blood results, and/or presenting symptoms, but we’re not, strictly speaking, trained for it.
The emotional impact This is divided into two camps: people who assume that nurses must spend their entire lives perpetually drowning in sorrow as a result of what they see at work, and people who assume that nurses are completely emotionally numb and, as a result, uncaring. The truth is probably somewhere in the middle. We do see a great deal of catastrophic changes in people’s lives. We do have to maintain a certain level of detachment, both in order to do the job, and in order to retain our own sanity. We genuinely do care, though. You know that adage that says “if you didn’t laugh, you’d cry”? Sometimes we laugh at inappropriate things, sometimes we look stoic when you can’t imagine how anyone couldn’t be moved to tears, and sometimes we cry, but mostly we try to keep the focus centered on the care of our patients and their families. Our grief at seeing a patient’s prognosis turn poor can’t begin to compare to the grief of that patient or that patient’s loved ones, so we pigeon-hole or compartmentalise our feelings, and carry on doing the things that need to be done to care for the patient. Actually, the ability to compartmentalise emotions is probably the most important skill a nurse can learn. If I have to deal with something that’s frightening or upsetting or disgusting or otherwise troubling, it’s important to be able to acknowledge my reaction to it, but put it on the back burner until the patient is cared for. I’m not trying to paint a picture of saint-like selflessness – I do this to protect myself, my personal relationships as well as to protect my patient. It’s just the reality of the job. And yes, I’ve locked myself in the bathroom to cry, out of stress or frustration or just sheer sadness, on more than one or two (or two hundred) occasions over the years. I’d be worried about any nurse who didn’t.
The sex thing No, not that sex thing (and now I suspect that you’ve been watching too much Gray’s Anatomy or Holby, but I’ll give you a few moments to stop thinking about Dr. Valentine, Dr. McDreamy or whoever). I actually meant the idea that nursing is a woman’s field. Some of the best nurses I’ve met with or worked with are men – and funnily enough, so am I. To my initial disappointment many years ago, they’re not all gay, girlie or somehow compromised by their professions, nor are they “just working as a nurse while they put themselves through medical school” (thank you, Friends episode in which Phoebe has triplets, for that stunning misrepresentation of the nursing career path). I won’t say much more about this, because I’m a man and cannot compare myself to the majority of my female colleagues, but I will say this – it’s bloody hard as hell to be a nurse sometimes, and both the women and the men have to be tough and smart. There are also some exceptionally bad male nurses – and terrible female nurses, but generally, most nurses are essentially decent and diligent, and work damn hard. They manage to care, often under negative conditions such as stress, understaffing, under-funding, under-supported and under-appreciated. Yet, they – we – carry on and do the best we can. Just a nurse? How annoying is that? As long as we’re sort of hovering around the subject, nurses aren’t the doctors who didn’t get into medical school. Nursing is a completely different specialist practice. If someone actually is working as a nurse just to get through medical school, then they might be on the wrong path. It doesn’t work. Nurses go to university for, at minimum, three years (not counting the pre-nurse exams/training/getting grades up to scratch and all the other prerequisites) to become qualified to take the finals and then obtain the coveted UK Registration PIN with the Nursing and Midwifery Council (NMC). Nursing courses in the UK are pretty tough to even get admitted to, and even tougher to stay on and tougher still to complete, and then you still have to pass exams, assessments, monitoring and maybe even convince the licensing people at the NMC that your prior criminal record was just youthful high-spirits (seriously, if you have anything worse than a speeding ticket on your record, you’d better be prepared to explain yourself, in detail). Then afterwards, we get the sublime joy of having people assume that we’re essentially McDonalds employees or cleaners or doctors-maids in scrubs. Would you like fries with your IV? Awesome.
The ego At the other end of the spectrum exists the people who assume we’re all incredibly full of ourselves. I have only this to say: if you’ve been a nurse for longer than five minutes, and you haven’t found anything to be humbled by, then you are in the wrong field.
In essence, nursing is a great big balancing act. It’s an art and a science, and those practicing it must balance confidence with humility, emotion with detachment, fear with nerve, and knowledge with intuition. It’s frightening and lonely sometimes, but that’s why we keep our friends around, and hope like hell that we’re working with a team that has our backs. I have had both excellent friends and amazing colleagues over the years. You know who you are, and I appreciate you, more than you’ll ever know. And that’s it really. For now… © 2012, Ryan Price
* * *Ryan Price is a Registered Nurse, freelance writer, photographer, designer and philanthropist. He is a keen supporter of the Cystic Fibrosis Trust and a passionate mental health advocate. His first critically acclaimed novel, ‘Wrong Rooms’ is due for republication in the summer of 2012. He lives in Penarth, South Glamorgan with his partner. For more information, contact email@example.com