A Nurses Story | Chapter 18 of 27

Author: Tilda Shalof | Submitted by: Maria Garcia | 1443 Views | Add a Review

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Within a few years, sweeping changes were underway. The administration was “restructuring” and creating a new vision of the type of institution a hospital should be. Cutbacks, bed closures, and nursing layoffs were the new realities. The first shock was announced at a staff meeting. Rosemary, our beloved nurse manager, had been dismissed. She told us the news herself.

“No one’s job is safe,” she said. “They even told me that anyone who thinks they can fall back on their seniority is going to get a big shock. They joked that bringing your lunch to work is being overly optimistic.”

We were stunned, except for Morty, who calmly explained the situation.

“Rosemary’s right. Staff nurses may be laid off, too. There are plans underway to replace nurses with cheaper, unskilled workers, to save money. They figure that the cafeteria pastry chefs can be trained to do bed baths, vitals, and so on. They call it ‘deskilling.’”

“Sounds like a frying pan,” said Tracy.

“That’s a skillet,” I said.

Morty explained further. “They want to get rid of us and hire new nurses with less seniority at a lower salary. They think they can get by with fewer RNS. Oh, it’s part of the Conservative government’s new plan of health-care reform. It’s only when the patients start dropping like flies that they’ll realize the value of nursing care. Didn’t you hear the premier of Ontario compare nurses to Hula Hoop makers? So much for the wage freeze and Rae Days of the NDPS’S Social Contract, welcome to the Common Sense Revolution. We’re feeling it now – the patients will be next.”

“I don’t get it,” said Nicole, who was the first to recover from the shock. “It’s not as if business is down. Patient acuity is higher than ever. Everyone knows the trend is that the population is aging. We’re going to need more nurses, not fewer. The ICU is always full with patients needing to come here and we’re always scrambling for nurses, especially with all the transplants we’re doing now.”

Frances nodded. “Remember what happened when that pair of lungs had to be sent somewhere else because we didn’t have enough nurses to care for the recipient?”

“Right now, all they care about is cutting costs. Slash and burn.” Morty shook her head in disgust. Even her curly red hair looked inflamed in reaction to this news. “Hospitals are going to merge with other hospitals to streamline services and eliminate duplication. They’re now public corporations and patients are now the ‘clients.’ Didn’t any of you read the results of the patient satisfaction survey? ‘Service is poor. I didn’t see a nurse all night.’ Or ‘The mattresses are too soft and my sheets weren’t changed for two days.’ Sure, there’s room for improvement, but the next thing you know, we’re moving toward privatized medicine, a two-tier healthcare system, and there’ll be one standard for the rich and another for all the rest of us. We’ll be like the States where people will have to mortgage their house to have their gall bladders removed. A lung transplant would bankrupt most people,” said Morty angrily.

Sure, we were worried about the patients and the health-care system, but what about our jobs? one of the other nurses asked.

“After they get rid of some of us,” continued Morty, “they’re going to require all nurses to have a university degree. We all better get back to school if we want to stay marketable.”

Everyone looked crestfallen and preoccupied as we took all this in, except for Laura, who didn’t have a degree and had no intention of obtaining one. She knew what she was worth to the hospital and didn’t care if they realized it or not. But it was worrisome news to me, even with my degree. Our jobs weren’t secure, yet we all knew we were needed. Once a month the doctors met to review the cases of the patients we had treated in the ICU, along with the reasons that some patients had been turned away. Invariably, it was due to a shortage of nurses. Other than that, we didn’t have much proof that nursing care made a difference. Yet we all knew that it did.

I looked at Rosemary, who looked more sad than worried. “But how can they get rid of you?” My voice squeaked in indignation.

I heard other rumblings and outcries from all the other nurses around me in the meeting.

“They can’t get rid of you,” Morty said. “It’s not as if there’s any problem with your performance. Your work is impeccable. They’re obliged by law to offer you something else, another position within the hospital.”

“They don’t owe me anything.” She gave us a weary smile. “It’s called retrenchment. They say my job is redundant. They need someone with more management experience who could be responsible for all the ICUS. But they did offer me something.” She spoke to us as a group in the same personal, intimate way that she spoke to each of us individually. “It’s a desk job in the education department. No patients or families or nurses there, just computers and paperwork. Most of the people who work there haven’t seen or touched a patient in years.” She sighed and looked defeated. “It’s sad because at the heart of it is the inability of administrators to appreciate what nurses do. They’re figuring out how long each nursing task takes so they can then justify paying for nursing hours. Like a bed bath, how long does it take and how many personnel are involved? They want to know how many minutes nurses spend giving patients emotional support. Five or ten minutes, they figure? That kind of thing.”

“How many points do we get for cleaning poo?” asked Morty. “We’ll be in the money if they count that!”

“That’s part of the problem,” said Rosemary, ruefully. “That’s probably all these administrators think nurses do. That’s why they believe they can bring in less-skilled people to replace you.”

Frances was in a huff. “It’s not as if when you’re doing vital signs or a bed bath it’s a task like hammering in a nail. While you’re doing that you’re talking to the patient, explaining their meds to them, taking a good look at the condition of their skin. You’re assessing if they need more pain medication. Planning when you’ll do their wound dressing and what supplies you’ll need.”

“Well, anyway, I turned down that job they were offering,” Rosemary told us. “I’m sure it’s very important work, but what nurses do and what nurses know will never completely find its way into the record books or e-charts. Maybe some of the doing, but not the knowing, and certainly not the being. How can you apportion a number value to caring in minutes or in dollars and cents? They say we have to be more accountable, that nurses are a commodity and must be used efficiently like any other hospital resource, but nursing by definition is an unlimited commodity. You can never have too much caring. There is no limit to how much one can give as a nurse and the need from the patient’s end is surely endless. Anyway, it’s just not in me to do that job. I’ll leave with the severance package they’re offering.”

We left to tell the news to the other nurses who were covering for us and get back to our patients.

LET’S START A petition or write a letter to somebody,” Nicole said to the group of us at lunch later that day. “There must be something we can do to save Rosemary.”

“This place will never be the same without her,” Frances said.

“Now, I love Rosemary as much as the next nurse,” said Morty. She took an energetic bite out of her sandwich, as if to fortify herself for the fight ahead. “But she’s not exactly a whiz with the budget. She’s become a dinosaur. I’m warning you guys, you better get more involved in the union or we’re all going to be the losers.”

“Rosemary was always on our side,” said Frances with a sigh.

“Yeah, remember when that family’s son threatened us like a gangster – ‘If Mama dies in this joint, I got a gun and I gonna come here and kill youse nurses.’” Laura made a slicing motion across her neck to show how the guy had meant business. It had been scary. When his mother did die, Rosemary took the threat seriously enough to have a security guard posted in the ICU for a few weeks to protect us.

“Remember how she baked a cake for the residents on the final day of their ICU rotation?” said Frances, who had already decided that she would carry on that tradition with Rosemary’s departure. “Who else but Rosemary would attend all the nurses’ weddings and baby showers and send flowers if we were sick? Remember that Christmas, when it was so busy with all of those donors and transplants, and she came in and took care of a patient herself?” recalled Frances.

“She could soothe the angriest family,” I recalled.

“Rosemary knew all of the patients and their families by name,” Tracy said. “She actually went out to the waiting room and sat and talked to upset families.”

“She’d talk to families before they got around to blowing a gasket,” added Nicole. “Remember how she would take them into that cramped little office of hers and she’d sit them down and ask them, what’s really bothering you?”

“I liked that poster on the wall in her office that said, ‘Go out on a limb. That’s where the fruit is,’” I said.

We remembered it all.

A NURSING ADMINISTRATOR came to the ICU to quell the rising discontent among the nurses. We were heartbroken that Rosemary had been ousted and indignant that the hospital didn’t appreciate her as we did. But a new nurse manager will be chosen who will raise the level of professionalism of the nurses, the administrator explained. Things were really slipping, she said, for example, the dress code. The appearance of some of the nurses was rather “inappropriate.” (“Sloppy” was the word she probably meant but was too tactful to say.) She also noted on a previous visit to the ICU that many nurses were drinking coffee in patients’ rooms and that some nurses had covered over the picture on their hospital identification badge with photographs of actresses and celebrities.

As she spoke, I looked down at my loose green scrubs. I always wore them about two sizes too large, for comfort and ease of movement, but truthfully, it looked like I was wearing pyjamas. There were a few drips of ketchup on my lab coat sleeve. I tried to hide my smile as I discreetly turned my hospital badge around so she wouldn’t see the picture of a young Elizabeth Taylor where my face should have been. (One distracted family member had inadvertently called me “Liz” one day and later we both had a good laugh together when she realized the joke.) There had been a quiet night at work and Laura cut up Maclean’s and People magazines and taped new faces on all our badges. Laura was Michelle Pfeiffer – a striking resemblance, I told her, give or take a few pounds; Nicole was Don Cherry’s dog, Blue; Tracy was the Pokémon called Pikachu; Frances was Madonna; and Morty was Bart Simpson.

The administrative executive was clear about our priorities: the hospital was millions of dollars in deficit. We needed managers who could bring the budget in line. Reduce employee sick time. Cut costs. Streamline services to avoid duplication. Replace nurses with less-skilled workers and pay them less. Change the skill mix, which was too rich, by making use of unregulated workers to replace more expensive professionals. Lay off nurses if necessary.

WITHIN A FEW weeks, Rosemary’s replacement had been chosen. Pencil-thin and statuesque, expertly made up and with a dark, sleek haircut, Sydney Hamilton was our new nurse manager. She strode into the ICU carrying a slim leather briefcase in her hand, a hand that was beautifully manicured and flashed a brilliant diamond ring. She could have been applying for the position of chief executive officer at a bank on Bay Street. Equally, she could have been pictured in a women’s magazine cover story with the headline “Having It All: Superwomen Reveal Their Secrets.”

At the staff meeting of the nurses and doctors, she brought out an easel, which she had set up ahead of time, upon which she had written her mission statement for the ICU. She stood before us and reviewed a series of graphs, charts, and diagrams to demonstrate the cost-saving measures and long-range planning she had in mind for the unit, based on her thesis for a Master’s in business administration, which was on implementing cost-containment measures in critical care. Then she sat down and opened a leather folder to a prepared typed speech.

“These are challenging times in health care,” she stated, turning to face each of us in turn. “But where there is challenge, there is also opportunity. It is a time of re-evaluating our vision of health care. Unfortunately, for many of our hospital workers, layoffs will be the new reality…. We need to look at ways to serve the customer better … increase hospitals’ revenues … become more fiscally responsible…. We need to make effective use of our health services through judicious allocation of our precious medical resources.”

“I think we are looking at real nursing leadership here,” said the nursing administrator when she returned to the unit to pay us another visit. “Sydney Hamilton has the polish and professionalism to make a strong nursing presence at the corporate table. She will be a force to be reckoned with if the topic of nursing comes up.”

I hoped that the topic of nursing would come up from time to time when the directors of the hospital corporation met for their annual general meeting.

WE’LL WEAR THAT Barbie doll down until she has a nervous breakdown,” vowed Laura. We were sitting in the lounge for our break. “I’ll fill that briefcase of hers with laxative beads. When she opens it at some meeting, they’ll fly all over the place. I’ll make fake poo with K-Exelate and cascara and leave it in a box on her desk. I’ll make a Sydney voodoo doll and we can put IVS into it with 16 gauge needles.” She rubbed her hands together. “Once she spends time with us, she’ll be running screaming to get out of this place. We’ll have a mutiny until they give us Rosemary back.”

“What are you guys plotting? Something I should know about?” asked Morty, joining us.

“Yeah, we’re cooking up schemes to get rid of Sydney Hamilton and bring back Rosemary,” said Nicole. “Even David Bristol said there’s no one like Rosemary. He said to know her is to love her and that she has a sterling character and a heart of gold.”

“Yeah, she’s a real gem,” said Morty, chuckling at the precious joke. “I think Daniel Huizinga already has the hots for Sydney, though. ‘Impressive credentials, a stellar performance,’ he said after that meeting, but I think he was referring to her legs. Listen, guys, get over it. I liked Rosemary as much as any one else, but it’s time to move on. Come on, if a head nurse is supposed to be a manager and not everyone’s friend, Sydney might be right for the job. Anyway, let’s give her a chance. Don’t worry, the union will keep her in line.”

Laura narrowed her eyes and spoke like a demon from The X-Files. “Satanic nurse manager rises to power, but there’s still no evidence of widespread devil worship.”

WE THREW A going away party for Rosemary. She had taken a job as an old-fashioned head nurse in the orthopedic ward of a small community hospital in Arnprior, Ontario, a country town where she and her husband, Bill, intended to retire. She promised to keep in touch.

IT WAS IMPORTANT to Sydney that the unit look attractive and she set about sprucing up the place. All the ward clerks were given brand-new office supplies, a pine green blotter for their desks, and colour-coordinated vests. New curtains were chosen for the patients’ room: Pepto-Bismol pink with matching vinyl swivel chairs for each room.

“When she gets done, this place is going to look as charming as a Victorian bed and breakfast,” said Laura. “Who’s been advising her – Martha Stewart? More importantly, why doesn’t she sort out the room numbers in this place? We’ve been merged, reorganized, moved, decentralized so many times that you can read the whole history of this place in the room numbers. Why is room 670 next to 605 and 616 next to 620 and why are none of these rooms on the sixth floor? They put one plan in place and by the time that’s carried out, a new one is already in the works. Not a day goes by when I don’t come upon some poor lost soul, stranded somewhere in this labyrinth, holding a pathetic piece of paper, looking for a room, or an office, or a department.”

Sydney beefed up the activities for Nursing Week. She helped make it more than just a roving cart of coffee and doughnuts for all staff. She made it more than just a free visit to the stethoscope clinic to get your instrument cleaned and oiled. She brought in guest speakers and provided workshops on stress management and career counselling, and offered gift certificates for massages for all the nurses.

But there were a few things she did that irked us. For one, she disbanded the lines that we had worked in for so many years.

“Nurses are not factory workers on an assembly line, punching in a time clock. You are professionals who can determine how and when you work. You have power over your work life, within the union agreement, of course,” she added with a nod to Morty.

She instituted flexible scheduling to enable nurses to go back to school, to take courses, to arrange their schedules to accommodate child care needs.

Another thing she did that felt strange to us was to put price tags on the equipment. Barrier cream to prevent pressure sores, $12 a tube. Ceftazidime, $88 a vial. Chest tube suction bottle, $23 each.

“Think twice before opening that pulmonary artery catheter tubing,” she wrote in the communication book. “Make sure you understand the rationale for its use and remember that each one costs $75!”

She wanted us to fight for frugality with the supplies, help rein in any profligate use of hospital resources, and eliminate wastefulness. She tracked everything carefully so she could report the extent of the money she had saved the unit after six months.

“Maybe Sydney could get a good deal for medical supplies on the Shopping Channel,” said Laura.

We eventually got used to Sydney’s ways and learned to respect her, but it was also around that time that a number of other disturbing things happened.

One evening at home I got a telephone call and I could hear only sobbing at the other end.

“Tilda, it’s me. Father Szigetti. Vince Szigetti.”

“What’s wrong?” We were friendly at work – he was with everyone – but he’d never called me at home before.

“They’ve fired me, my dear.”

“Why you? Surely you don’t cost the hospital any money!”

“I’ve been called before the parish and they’ve taken away my hospital duties. They’ve sent me on a silent meditation retreat for penitence. They say I’ve been too familiar with the nurses. They say I hug the nurses too much and touch them inappropriately.”

“I can’t … I can’t believe it.” Some things made me speechless.

“That’s not all, my dear. They’ve accused me of telling homophobic jokes. I’ve always known there’s a Lavender Mafia out there and it’s been going on for years. Some of us call it ‘Notre Flame.’ I may have told a joke or two, in fun of course, but no harm was ever intended.”

“You know how sensitive people are these days, Father. One has to be so politically correct.”

I couldn’t help but remember the joke he’d told in the med room one day about the gay church where only half the congregation was kneeling. Didn’t we all laugh at that one?

“But I’ve always said that homosexuals can make good priests. Of course they can. As long as they remain celibate. The teachings of the Bible must be upheld. We need to bring more discipline back in the church. And there’s another crime I’m wanted for, my dear. They accuse me of proselytizing. They say I’ve been putting graffiti around the hospital, just to offer a bit of inspiration to the nurses and the patients.”

“But is it true, Father? Was it you who did that?”

Was I taking confession from a priest?

“It’s perfectly harmless. In these trying times, my dear, all the more is the need for people to hear the word of God. A man is a priest forever, either to his greater glory in Heaven or to his damnation in hell. Please write a letter on my behalf to vouch for my character.”

“Of course I will,” I said.

“I will need your prayers, my dear, to get me through this crisis.”

I assured him that he had them and vowed to start praying.

But another call I received a few days later informed me that even more urgent prayers were needed.

“Tilda, it’s Tracy.”

“Hey, Trace, how are you feeling?” She was ten weeks pregnant with their second child – Jake was already three years old – and was having a rough first trimester.

“I was feeling better until I heard this news. I’ve got bad news and bad news. Which do you want to hear first?”

“Let’s go with the badder one.”

“The first one is badder for me and the second one is badder for you.”

“Okay, shoot.” I was feeling great. We had just bought a house. I was pregnant too, feeling fine. Nothing could bother me.

“You remember that patient I took care of a week ago? He was a travelling businessman who had gone to Singapore and has had a respiratory infection ever since he returned? Well, he’s really sick and the test results just came back showing that he’s got tuberculosis! I took care of him and that exposed me to an active case of TB. They want me to have a chest X-ray and are recommending I take a course of rifampin and isoniazid and all those other TB drugs.”

“Did you tell them you’re pregnant?”

“They say it’s safe to take the drugs during pregnancy. I don’t know whether to believe them or not. What choice do I have? They say my risk of getting tuberculosis is greater than the risk of the drugs harming the baby. Now, are you ready for your bad news? I’m sure Sydney will call you later, but a bunch of us at work just discovered that pink slips really are pink. Five hundred nurses have been laid off at the hospital, twenty of them from our ICU, and I’m sorry to tell you, Tilda, but you’re one of them.”


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Great book, nicely written and thank you BooksVooks for uploading

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