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No, I'm not a patient.  As you might guess from the screen name, I'm a nurse.  31+ years of it now, and still love it.  Of course, I have one of the more fortunate jobs in nursing - cardiac rehabilitation/cardiac patient education.  And even though my work is not quite the 24/7 of inpatient bedside nursing, heart disease continues every day and my work does too.  While I rarely have to spend a whole Christmas at the hospital, tomorrow will be one of many Christmases I've spent part of there.  And I feel in the mood to share a few random thoughts.  No great revelations, nothing earthshaking, just the thoughts the day brought.

I worked today - just got home - and the mood in the place was amazingly nice.  Maybe it was just the crew I worked with, but there seemed to be special sweetness in the interactions of people today.  All the food no doubt helps a bit - cookies, fudge etc. everywhere you turn!
I work per-diem - meaning irregular schedule, no benefits - and I fill in for other people's time off.  The nurse who works mostly with the heart surgery patients is traveling, so I get to do her job which, on a good day, is probably the best around.  Pre-op and post-op education for heart surgery patients and their families, and (the really fun part) keeping families informed of the progress of surgery during a case.  So when a surgery is happening, I dress in scrubs and go into the OR a few times to give families a report on progress and reassure them that their loved one is OK.  The approximately 2 times in 100 that a surgery does not go well, you really earn your money in that job.  But the rest of the time it's just fun.  Families are so grateful for the news that if you just do it competently, they think you are an angel.  And to be honest, I'm rather better than just competent at it.  I've become a master of calm and reassuring.  Every detail matters for an anxious family - showing up when you say you will, having the right expression on your face when they first see you coming, etc.  
It's been a busy few days for surgery - including 3 cases done last Friday, all of which will likely go home tomorrow - exciting that they get to go home for Christmas! - and that's why I'll be going in for a few hours, to help make sure the discharges go smoothly and everyone has all the knowledge they need to succeed at home.  All of those were more or less urgent cases - all multi-vessel bypasses - and I did the liaison with families on all of them - so they know me, and my being there to reassure them at discharge will lessen the stress for them a bit.
I never really mind working holidays.  As an RN, I knew that was part of the deal when I chose this work, and - as a union member - I get paid quite well for it.  Plus there is a certain camaraderie and shared kindness among those working.  I feel sympathy - more than sympathy, outrage - for people forced to leave their families to work Christmas for minimum wage.
Another little note: I was musing today with another old-timer about how much things have changed in Christmas at the hospital.  30 years ago, the patient census would drop by 50-60% for the whole week from Christmas to New Years.  Whole floors would be closed and we'd have a small crew on.  Today, the place was essentially full and is likely to remain so.  Why the difference?  30 years ago, a large percentage of hospitalized patients were there for elective procedures that are done today as outpatient cases - in in the morning, out in the afternoon.  Much of that is technological - laparoscopic surgery and the like.  Some of it is driven by pressure to cut cost.  We also laughed about some of the patients we used to have with diagnoses that would never make it in the door today - probably appropriately.  My favorite was "exhaustion".  The typical exhaustion patient was a well-off, well-insured, moderately overweight white woman whose "exhaustion" consisted of being tired of her family.  She'd get her doctor to admit her with an order for narcotic pain meds.  She'd get a private room where she would smoke non-stop (patients could do that then) and call for her drugs every 4 hours around the clock until she got bored and went home.  I can only imagine what the utilization review folks at an insurer would say about that one today!
By comparison, today, most of the patients in a hospital are seriously ill.  A great many of them are people who would not have survived at all 30 years ago.  new drugs, new techniques have changed their outlook from certain death, to challenging illness. They have illnesses that can't be scheduled, so they come in regardless of the day of the week or day of the year.  And we are there to meet their needs.  As I hope to be for a few years more

Originally posted to Chico David RN on Tue Dec 24, 2013 at 09:04 PM PST.

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