Outside Looking (Back) In

I am a Registered Nurse. Although I have been working outside of the nursing field for the past few years, I have more than 30 years of nursing experience under my belt. I have always been proud of my profession, and was thankful that I had a career that I enjoyed and to which I could always return. But over the past month, as my mother has been seriously ill and hospitalized, I have been a daily visitor to the world in which I used to work, and my sense of pride in being a nurse has been sorely tested.

I am shocked by what I'm seeing. The problem has not been with the doctors or the paramedics we have encountered at two large, teaching hospitals affiliated with a top university, but, to my dismay and amazement, with my fellow nurses.

The first thing I have noticed is visual. I'm not the only one who has noticed this – it's something that is striking enough that people outside of the healthcare profession have commented on to me. There is lack of professionalism in appearance among many nurses. Whether at the start of a shift or at the end, I have observed that the majority of nurses look like they have just gotten out of bed, with wrinkled clothes and unkempt hair. I know what it's like to work full-time, to work all night then get called in to work again the next day, but I've never seen nurses looking so bedraggled. Don't for a minute think that I believe that we should go back to the days of starched white uniforms and caps! I'm talking about the difference between looking slovenly and looking a bit worse for wear at the end of a tough shift. I have observed that the younger nurses tend to be sloppier in appearance than the older nurses, but those of my vintage are not above reproach. What is the problem? It's obviously not impossible to be professional in appearance, because it was once the norm, and there are still nurses who are. Do the younger nurses think they're still in college and the older nurses no longer care?

The next unpleasant surprise has been repeatedly being made to feel like we're bothering the nurses, and that, as they stare at the monitors and don't look patients in the eye, they consider caring for patients an inconvenience. But perhaps the most vivid memory I have is of being alone in an elevator with a nurse who was starting her shift one evening. She was yawning loudly, stated that she should have a year off with pay, and then moaned about having to go "back to the grind." Griping is normal; we do it all the time. But what is also normal is to be circumspect about one's audience when one is letting off steam. She didn't know who I was – a visitor, an off-duty staff member, or a patient back from a day pass. I bit my tongue and thought, "I'm glad you're not looking after my mother."

Finally, I noticed a real difference in care provided by nurses in specialty areas, in this case, oncology and emergency, and the care provided by nurses on a ward. Unlike the specialty nurses, the ward nurses I have encountered seem to have a lack of knowledge in terms of basic treatments, such as the importance of fluid balance and proper aseptic technique. Am I being unrealistic to expect that all nurses at least know the basics? Have nurses become so sub-specialized that they can't put together a whole picture of a patient, e.g. a telemetry unit only sees the heart, and cannot see problems of the kidney or those related to leukemia?

Unlike me, my mother, who has no medical background, is unaware of the errors in basic technique and treatment. So what is someone who is not a nurse to do? How can patients advocate for themselves, or a person advocate for their loved ones when they don't know what to look for, or how things should be done?

I never thought I would be writing such things about my fellow nurses, but this experience has made me wonder where the professionalism of my fellow nurses has gone. But perhaps more importantly, where has the caring gone?

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