In a land not so far away, during a time not so long ago, there lived Once Upon a Time Nurse. She polished her shoes and she starched her cap and she walked through the halls of her bright and sunny hospital greeting colleagues and strangers alike. She reviewed her charts (on paper, too!) and arranged her medications, giving injections using anatomical landmarks before sterilizing syringes. She washed her patients without gloves on and assessed every inch of their skin, only to make their beds with mitered corners on fresh linens that were as snowy white as her uniform. While she was always busy, she could rest assured that she would have enough time each and every shift to hold a patients’ hands; wipe away their tears; or teach them something new. While the Once Upon a Time Nurse faced struggles and challenges and barriers to care, she could always put her patients at the forefront of her day.

Fast forward to the Modern Day Nurse. Modern Day Nurse hears the sound of her alarm and hits the snooze button twice. She is still exhausted from her previous twelve-hour shift (which is never only twelve hours) and needs just five more minutes in a dream-like state before entering reality. Perhaps Modern Day Nurse packs lunches or drops off children or was awake all night doing a term paper for school. Regardless, Modern Day Nurse is never quite able to catch up, and today is no different. Modern Day Nurse stops by the coffee shop to pick up the usual before clocking into her shift. Another emergency admission. Another nurse short. Another turn of events, and while she understands that situations can at times call for extenuating circumstances, this pattern has become more the norm than the exception. Modern Day Nurse is in charge today: she takes a deep breath and an extra long swig of her coffee. Modern Day Nurse peers in from room to room, noting that the patients are toeing the line between living and dead, yet her mandated paperwork will consume the better part of the morning. She must somehow manage to care for her own patient assignment, serve as a resource to other staff nurses, attend mandatory meetings, conduct metric analysis audits, participate in grand rounds, account for daily staffing, settle cases fresh from the operating room, handle disgruntled families who are going through the hardest days of their lives, and anticipate a code blue call at any second – all with a smile on her face, because reimbursement is contingent solely upon her capacity to please and appease through the bullshit.

Modern Day Nurse is accustomed to buzz words like “lean,” “pared down,” and “fiscally responsible.” Modern Day Nurse feels a deep and resounding sense of guilt when she cannot reposition the pillow beneath her patient in a timely manner. A bedsore is so much more than a detriment to the patient: it may cost another staff member their job. And if that sounds utterly bat-shit crazy, it’s just that: totally nuts. Modern Day Nurse understands the lunacy of it all, but she must actively participate in the madness anyway.   If she doesn’t buy in to whatever flavor of the week her institution is selling, she may find herself without a badge the next day. But alas, we are operating in a “modern era of healthcare.” We must shift with the ever-changing tides of the healthcare domain, and much of this includes conducting tasks and collecting measures that were created by people who have never had to touch a patient a day in their lives. Modern Day Nurse must check boxes and click on screens and scan medications and chart progress notes in a timely and thorough fashion, all while making certain to clock out on time. Modern Day Nurse understands that time-management is damn near impossible, so she eats Power Bars from her scrub pockets instead of taking lunches. Modern Day Nurse tries to take on too much too soon because she can’t stomach the idea of getting home from the hospital two hours late (again) and explain to her family (again) that work was just too crazy to leave on time. “Eventually,” Modern Day Nurse thinks to herself, “My family won’t believe me anymore…” So Modern Day Nurse tries to multi-task where she must and cut corners where she can…carefully…quietly…not because she’s a bad employee – in fact, she cares too much. But if it means she forgets to chart some godforsaken detail in a monotonous flow sheet: well, so be it!

What are they going to do, fire me?

Modern Day Nurse knows in the back of her mind that they actually might. Modern Day Nurse is keenly aware of the fact that her complaints may seem to fall on deaf ears, but they indeed stir the pot, which, it seems, will never boil. Modern Day Nurse is constantly balancing fierce patient advocacy with self-preservation. Modern Day Nurse is desperate for a way to fix the status quo, but barely has enough time to pass her morning medications.

Modern Day Nurse looks up at the clock and realizes that it’s almost noon. She has barely had a chance to see her own patient since the morning assessment, and makes an appearance at the door. She apologizes profusely to the pre-surgical elderly patient who is quietly watching the midday news. Modern Day Nurse drops off the patient’s tray and proceeds to explain, “I’m so sorry I haven’t been by! Being in charge is always very busy!” Modern Day Nurse is grateful to elicit a smile from the appropriate charge assignment despite 100% occlusion of his coronary arteries.   After a brief conversation and a sigh or relief that the patient has taken a midday nap, Modern Day Nurse proceeds with helping to escort an unstable patient to CT Scan or wash an incontinent patient with an overwhelmed nurse or hang a bag of blood for a hypotensive post-op who is out of bed in a chair. Modern Day Nurse is astute at putting out fires. Modern Day Nurse spends her entire shift on damage control: whether it’s a bona fide life or death emergency or something so insignificant it makes you want to rip your hair out, Modern Day Nurse deals with it over and over again, hour after hour, shift after shift.

And what thanks do we bestow upon our Modern Day Nurse? Too busy with too many patients who are too sick and only becoming more unstable? How do we show our gratitude for her service to not only patient care but also all of the ancillary poppycock that comes along with it? A pen? A lanyard? A water bottle? Perhaps a pizza party? What resources do we provide to our Modern Day Nurse, who swears today is the last day she will take this shit but comes back the next morning ready for more…a smile on her face; guilt on her conscience; wanting to flip off anyone who asks her to work an extra shift but keenly aware that her patients and team may suffer if she doesn’t suck it up for one more day? What help do we give to the Modern Day Nurse – choking back tears; fighting off ills; aching and broken by a system that’s breaking?

Modern Day Nurse, with her hair out of place and her patent shoes scuffed. Modern Day Nurse, with a pocket full of alcohol wipes tracking her hourly vital signs. Modern Day Nurse, who despite the rules and regulations; regardless of the metrics and measurements and parameters; will drop it all to rush into a room and save a life. Compressing while shaking, pushing and breaking, shocking that ugly rhythm – charting be damned! Modern Day Nurse, who is intelligent and insightful and can think critically and care deeply but is all but replaced by the latest evidence-based fad. Because while Modern Day Nurse may not be so prim and proper as her predecessors many shifts ago, Modern Day Nurse knows that someday – when she walks away from this Modern Day Nightmare – she will have held a hand and wiped a tear and saved a goddamn life.

Once Upon a Time, nursing was quite simple. Modern Day nursing is harder than you’ll ever know. When Modern Day Nurse finally burns out; turns over; clocks out of work for the very last time; I can’t help but wonder…how will your mandates and metrics add up then?

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