[Note: I wrote the bulk of this article several years ago after having retired from the profession of hospital and medical group management.]
“Gwen, how did Mr. Kranski do last night?” inquires Dr. Sam Largo of the Day Shift Charge Nurse of the Medical/Surgical Nursing Unit, Gwendoline Pattison, during his morning rounds at Community Hospital.
This opening scenario can trigger any number of responses in the reader, such as:
How dare the doctor call her by her first name; will she respond by using his first name? The answer to the latter is ‘maybe,’ depending on her age and upbringing, the degree of familiarity between the two and whether there are patients or visitors within hearing distance. In the hospital setting, however, this kind of question is not as important as in other settings.
Gwen is probably a mother figure to the young doctor and he relies on her experience to help him judge the progress of his patients. This is a possibility, but they could just as well be a 60-year-old internist asking a thirty-year-old nurse clinician about the activities and observations of her colleagues that are passed on to succeeding shifts of nurses about all patients in the last twenty-four hours. How did the patient respond to medication? How did he sleep? Was he more or less alert? What are his vital signs? How did his bowels and urinary system work? How do these and other measurable and un-measurable things all interact to give a whole picture of the patient’s progress?
What is a Charge Nurse, the boss? Does she tell all the other nurses what to do? She is a “boss,” up to a point. She is responsible for assuring continuous assessments of patients’ needs (as many as twenty-five patients at any given time), assuring there are sufficient numbers and kinds of nursing personnel to serve them (registered nurses, licensed practical nurses, nursing assistants) and running interference for all these people so they can get their jobs done. But what tells each what his or her job is? It is the interaction of these imperatives: the written and verbal orders of the patient’s physician; the tenets of the profession of nursing; state laws and regulations; and, this hospital’s policies and procedures. Where any of these may seem to conflict, the charge nurse makes a decision or asks counsel from the Unit Manager or the “House Supervisor” (nurse administrator of this shift). Any significant deviation from these and other imperatives are documented by the Charge Nurse and sent to the Nursing Administration Office for study and follow up.
Why is it in such stories that the doctor is always a man and the nurse is always a woman? around 5% of registered nurses are men; around 25% of all physicians are women. Persons experienced in hospital work, nurses and otherwise, will generally concede that, despite the exceptional male, women are particularly suited for the intellectual and emotional requirements of the very demanding profession of nursing.
Gwen and the doctor are probably friends. Maybe, but unlikely if the inference is that they have a friendship outside the workplace. There are circumstances where nurses and physicians marry each other and retain friendships within the profession of each, thus creating a small social group of doctors and nurses; but such are unusual. Physicians tend, generally, to socialize with other physicians. The on-the-job friendship is based mostly on mutual respect and a strong feeling of interdependence in working on the hospital patient’s behalf. Another generalization is that mixed friendships outside of work is more likely in small towns than in large ones.
Of course, these hypothetical responses are merely to give some flavor to this workplace scenario.
The professional life of the nurse
Although hospitals prefer to hire nurses willing to make a commitment of at least two years, many nurses find it possible to spend their early working years traveling the country from one six-month or twelve-month job to another, until they reach a major life decision such as marriage or a permanent job in a preferred setting (or both).
A nurse can become “Registered” in her state with as little as two years of schooling beyond high school. It does take a while longer, however, to become proficient in caring for hospital patients under the guidance of more experienced nurses.
Readers who are experienced hospital nurses will see how much of their different jobs I have not mentioned, for instance: the rewarding and sometimes stressful interaction with other persons serving the patient, such as laboratory technologists, imaging technologists (x-ray, etc.), physical therapists, dietitians, housekeepers and others. The stress derives, usually, from trying to schedule and re-schedule all these people as the patient’s condition may change and as the physician’s orders may be given. Many wonderful friendships have formed among such people as they work together under difficult circumstances for the benefit of ill and injured people.
There are also the special working circumstances of the emergency department, the operating room and the intensive care unit.
Depending on the locale, the emergency department can be as exciting as being in a continuous disaster zone, with occasional breaks for cleanup, assessment and mutual teaching. This kind of activity is not eveyone’s cup of tea, but those who thrive on excitement find it exhilarating and a great source of pride. Team spirit among all personnel is usually very high.
The same can be said for those working in the surgical suite, or “Operating Room,” where some of the patients first seen in the emergency department are sent for repair and life-saving procedures. The atmosphere is very much more controlled, and is more like a ship in its organization, the surgeon being the captain. There are different rewards here for those who value the intricate, painstaking and lengthy procedures in which all personnel must participate to assure the best outcome for the patient.
The intensive care unit (sometimes called critical care or special care) typically receives the patient from surgery or directly from the emergency department. The atmosphere is calmer, except for the occasional reversal of condition or a cardiac arrest in a patient. People do die here, and it is a challenge to deal with the sense of loss and to support one’s colleagues. It is common for a nurse to participate in patient conferences alongside physicians of varying specialties who discuss the significance of the patient’s signs, symptoms and test results for the purpose of advising the patent’s primary physician on a course of medical action. (Some hospitals use “hospitalist” physicians as the manager of the patient’s care).
Those in administrative nursing are at least a step removed from direct patient care, but they typically have spent a significant amount of time with patients before choosing management. Some are in line management, directly supervising large numbers of people, or in staff positions performing specialized administrative functions. The latter can include Infection Control, Utilization Review, Quality Assurance (now changing to Continuous Quality Improvement), Staffing Coordinator and Inservice Education Director (or instructor).
I have not addressed the pay and benefits a hospital nurse may currently enjoy, but these may be discerned by an Internet search, such as this.
Nursing is an honorable profession, no less important to the hospital patient than his or her physician. Just ask any physician how he would be able to cope if his hospital was unable to find the right number and the right quality of nurses for his patients. Should this happen, he will be quickly in the hospital administrator’s office demanding action to relieve the problem.
Hospital nursing is not for everyone, but luckily for those of us who will need them, there are those who have the emotional and intellectual resources to enter and remain in this most vital, challenging and rewarding profession.