The Nurses by Alexandra Robbins

The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital

2015. Workman Publishing. ebook. 368 pages.

In a nutshell:

The Nurses is a deep-dive examination of what it is like to work in the nursing profession today. Robbins’ book follows four ER nurses through the events of one year. The names of the nurses and their hospitals have been changed to protect their identity, and of course the city where all of the nurses work is never named. One nurse battles the temptation to relapse into narcotics abuse after the death of her mother; another nurse is newly minted and trying to find her place; the other two nurses have their own personal and professional challenges. These four narratives are balanced with chapters of well-researched discussion of the challenges facing nurses today.

Review:

When I was a freshman in college, I lived on a dormitory floor that held a contingent of students from the rigorous nursing program. I had a lot of respect for them as I witnessed the stress of their studies; on occasion, I helped them study for anatomy by flipping flashcards. On Thursday nights, the nursing students had a tradition of gathering in the lounge and watching the tv show ER. I don’t think they necessarily held it as a realistic example of the hospital environment, but I suspect it helped keep alive their inspiration as they waded through their studies. I remember all of them as being tough, kind and smart, exactly the kind of people you would want looking after you in your time of need.

As evident in The Nurses, Alexandra Robbins also holds the nursing profession in high regard. She doesn’t gloss over issues such as the practice of more experienced nurses often “eating their young” or the fact that nurses aren’t immune to workplace cliques, but her main goal is to educate the public about nurses and to tell nurses’ stories. Robbins’ journalistic career has mostly been in the realm of education, but nurses kept asking her to tell their stories, and once she heard the stories, she was hooked, as she says in this interview on BookPage.

One of the main misconceptions about nursing is an old one: the idea of nurses as “hand-maidens” to the god-like doctor. The reality is that nurses are a vital part of the medical team treating the patient, and the “hand-maiden” paradigm is detrimental as it can lead to doctors discounting nurses’ wealth of knowledge, or even doctors mistreating nurses. And the blame for something going wrong disproportionately falls on the nurses. In one account, a nurse verified a dosage with a doctor six times; she had misgivings on the amount, but was unfamiliar with the medication, and it was unlisted in the drug handbook available to her. On past occasions, when she knew the medication, she had no qualms of overriding the doctor. In this case, she did not. The dosage did turn out to be wrong and though the doctor took responsibility for the mistake, the nurse still was written up in her record because she was the one who administered the medication.

I really appreciated the inclusion of the ER nurse who had a past narcotics addiction. What started with a legitimate prescription for Percocet spiraled out of control as the stress of her job and life led her to take advantage of her easy access to morphine and other narcotics.  After hitting rock-bottom, she enrolled in a strict rehab program specifically tailored for medical professionals, which got her clean and eventually eased her back into the profession. Throughout the year covered by this book, she faithfully attends Narcotics Anonymous meetings several times a week. Her story is not unusual; the nursing profession is vulnerable to addiction due to the stress and access to powerful drugs, though many institutions have put in protocols that have made it less easy to get the drugs without being noticed.

Another shocking aspect to the nursing profession is the frequent lack of a safety support structure to protect nurses against assault by patients, patients’ family members, and even other staff.

This is precisely what a Massachusetts judge told a nurse when he threw out her case against her attacker: Getting assaulted is part of the job. This attitude, which I’ll call the “shrug-it-off culture,” can make nurses feel that reporting an attack will reflect poorly on the nurse as an individual, as if the violence is a result of their own negligence or weakness. Partly because assaults are so common, the industry has conveyed that being attacked is acceptable.”

Some institutions are taking appropriate measures. Robbins specifically praises the Veterans Administration Medical Center which decreased the number of violent attacks by 91.6 percent after installing a database to identify patients with a history of violence.

The Nurses casts a critical eye on patient satisfaction surveys, a piece of the Affordable Care Act that can affect Medicare’s funding to hospitals. For example, “the survey doesn’t ask whether the hospital resolved or improved the patient’s medical issue, which one would hope would be the primary determinant of a patient’s satisfaction with the experience.” In early version of the survey, a comment section highlighted how erratic patients’ ideas of “satisfaction” can be, as some patients complained about things like a lack of Splenda, or a dying roommates’ noisy breathing. And of course, there are obvious shortcomings to such surveys: “Molly clocked out and stayed for two hours holding a dying man’s hand because he did not wish to die alone. He won’t be polled about his hospital experience.”

The last chapter of The Nurses is called “What You Can Do: Advice and Inspiration for the Public, Patients, Families, Nurses, Aspiring Nurses, Managers and others.” A few of the take-away points for Patients/Families:

– Appoint one family spokesperson.

– Ask questions – instead of “why” which can put staff in defensive, phrase it more like “help us to understand why he’s getting this medication”.

– Bring hand sanitizer and antibacterial wipes.

– “If you want to help the nurse, ask what you can do for the patient.” – family members can bathe patient, “brush their teeth, take them on walks, participate in therapies, and handle feeding”.

Not listed in this chapter, but something I gathered from the book overall, is to try and seek a hospital with a high patient-to-nurse ratio.

It’s funny, for all that this book highlighted the challenges and toughness of the nursing profession, it kind of does make you want to drop whatever profession you are in, and go become a nurse to care for people and save lives. And then, following on the heels of that thought, I admit to myself that I am probably not thick-skinned enough to succeed in that environment.

On that note, I will conclude with one of the most moving accounts in the book:

Juliette was hooking the woman up to the cardiac monitor when the patient took her hand and said breathily, “I just want to say good-bye.”

“What are you talking about?” Juliette said. The words sounded strange.

“I’m just going to say good-bye,” the woman repeated. Her eyes went vapid. The monitor showed the woman’s heart rate plummeting to zero. There was no time to press a code button. There was no IV to utilize.

Juliette didn’t even think. She did the precordial thump, a method of resuscitating a patient in cardiac arrest: She raised her forearm to her nose and brought it down hard on the woman’s chest. The woman opened her eyes and burst into tears. She seemed to know exactly what had happened. “Thank you,” she whispered, grasping Juliette’s hand. “Thank you.”

 

Excerpts from others’ reviews:

Book’d Out – “Written with heart, detail and honesty, Nurses is an eye opening look at the frustrations and joys of this undervalued profession. A must read not only for any one contemplating joining the field but also for those already embedded within it, and anyone interested in what really goes on behind the scenes.”

The Book Nurse – “I’ve been a Registered Nurse for 37 years and have practiced in many different settings in hospitals, clinics, EMS, education, publishing, and, now as a school nurse. I can’t think of another career that provides so many different avenues for change and self-fulfillment from one basic degree. As one quote puts it, “nursing isn’t just a job — it’s who I am.” I could relate to almost every scenario presented in this book, and only wish that it had followed the stories of nurses from other departments besides the ER.”

The Nurse Teacher – “I felt like someone had followed me around for my career and took notes.”