This blog has been rather empty than full of interaction for the past three months. We’re busy, busy by just living day by day and not doing special missions for any secret society. My life has not changed much, it just became more unclear about what I really want to do with my life.

I transfered from Intensive Care Nursing to a Normal ward, urology and andrology, a subject which catched up my interest very early and my nursing training never got me the chance of actually working on a urology floor, sad but true.

The work is not less demanding than Intensive Care Nursing. Intensive Care Nursing is more technical, more detailed and more focused. The basic care nursing like washing patients, wiping butts and so on is not as important as keeping the patients alive. Literaly, it way my job for 7 long months and I enjoyed it, I enjoyed the freedom I had and I really enjoyed the close relationship to excellent doctors and other members of the team.  Also the constant flow of new knowledge and the constant questioning of yourself, your theories and your work is very demanding and rewarding.

Sadly, my fellow nurses where just the pack of shit. There was no teamwork, there was no team you can lean back if you had a bad day, there was no mentoring or teaching philosophy it was everybody on their own, everybody fighting for himself and his patients. Why is it so important?

On one shift I lost four patients, one of them in my age

I witnessed children getting abused by their parents in a way you couldn’t imagine, in a way that just brings up rage and sadness

We did CPR for four hours in one night shift on a 16 year old stab-victim, unsucessful

I was physically attacked by patients in psychosis or just the way they are in normal life

These cases are of course, extremes. Many shifts on an operative Intensive Care Unit are just admissions of patients from some major  operation. The majority of patients comes planned, multiple traumas , road traffic collisions and abused children are the 10% of the whole spectrum, but these 10% stick with you. After trying to rescue this sad fellow with a knife in his chest and 18 stab wounds, everybody just stopped and went on like it was a normal day. Of course if you witness a lot of this shit, you get polished up and don’t think about it anymore. Intensive Care Nursing is very analytic and sometimes methodical, more than any other specialty. But sometimes you got a bad feeling in your stomach, that something went wrong and you don’t know exactly why and this is the point where you sit together with your colleauges and just talk about it.  Not in particular about technical mistakes , just about the mood and how everybody is feeling. It never happened
On my old ICU, as a student nurse I had a mentor…tough nurse really tough and just throwing questions at you like a knife thrower. Everyday he challenged you and the questions where getting more and more difficult, just letting you suffer through the anatomy of the lungs and whatever.

We had a Code Blue on a medicine ward, old women 98 years with cardiac arrest…the code pager went on , he looked at me and said: “Today is your big day, code leader!”

I was the one who lead the ACLS process, of course with a big ammount of guidance from my master of nursing, after 30 minutes the old women was back.

After my first real big code, I felt wrong. Why resuscitating a 98 old women with cancer and multiple life – threatening diseases? After two days, I felt sick and I was always thinking about: What did I do wrong? Was there something wrong with my CPR? Was it right to push this code on for 30minutes?

I just sat down with my mentor, and we talked…for 2 hours. Not about coding, about life, about ethics and finally about our performance as a team. He just told me, and I remember these words very clearly

“Sometimes, our job is just pushing on, not questioning ethics or is it right or wrong…it’s about your gut’s feeling,  if you should do something and what you should do. And sometime in your career, right is wrong…and wrong is right!”

These two hours of talking and reflecting was better than any psychiatric trauma counceling. It was just great to have an old nurse covering you up, backing you up and so on.

My theory about ICU-Nursing is: IF there isn’t  something like mentioned above, the whole team can do shit!

This was the reason I quit and transfered to Urology…and my choice felt great.

The whole Team in the Urology is a pack of crazy fellows. Everybody on these wards is a lunatic, and this is why the work was so much fun. There isn’t a single day without the obvious verbal fights between us, and everybody is laughing about it.

The work is hard core….42 beds on a big ward (2 fifty meter floors) , sometimes up to 10 operations per day, four intermediate care beds and emergency department for urology and andrology. We try our best, but we cannot do everything. Sometimes our patients cannot be threated in the best way possible.

On the floor, and this is something I hate to say you really learn how to be a nurse. If you start right up with ICU – Nursing, you have all the technical toys avaiable, always the best equipment to make everything easier. The real world of nursing is much more different. Instead of 2-3 patients you have to focus and prioritize 12,14 and even 42 patients on the same time.  You constantly have to re-focus and plan ahead, what might be coming, what might be important now. It’s a thorough process, and it’s learning the art of nursing the hard , but best way. Down, on the dirty floor.

I now transfer to a big universital hospital….Nurse Anaesthesist or Anaesthesiology Nurse…whatever the name is…I will work in the department of anaesthesiology, mostly in the operating rooms as a two man team…the Anaestesiologist and me. No or very limited basic nursing care (maybe in the post-op recovery unit) and MUCH more technical than ICU Nursing.

I chose to do this, because I’m sick of the whole nursing process. I’m sick of the constant, frustrating  social-work I have to do everyday in my job and the constant staff reduction in my department. All I’m getting “payed” for is the procedures. Emptying cathethers here, doing a central line here, complete wash of a patient in bed two times….in June I spoke 90 minutes with a sick, dying man in his last hours of existence. He told me everything and confessed the major sins of his life. He just wanted to tell somebody before he passes away. There is NO line  in the nursing procedure sheet where I can put my signature for speaking with a sick, old and lonely old men.

I get confronted with misery every day, but sometimes it’s just too much. I had a patient, which had his kidney removed. A very soft, gentle and very good man who already had two strokes and couldn’t do anything. His speaking was affected, his left eye was open all the time and red swollen. As I took over the morning shift, I found him in the bed, with so much pain that tears were in his eyes, but he couldnt’ say anything. The nightshift was too busy with admissions and less sicker patiens with a kidney stone, so they couldn’t look after him and his pain level. He was in a clear and reasonable state of mind, he percieved everything and we had to put in a nasogastric tube, an arterial line, a central line and all of a sudden he crashed and his oxygen saturation went down. I felt so damn sorry for this guy. He died alone in his bed on another ward, because his family didn’t really care for shit and left him alone, never visited him and they where even too damn lazy to bring photos of his nephews and grandkids too his bed. He told me in the last words I heard from him, he loves his grandkids and nephews but I should not call them, they’re way too young to understand all this stuff.

I can deal with stories like this, I have no emotional problems and I don’t have nightmares about my patients. It’s worse, it leads to the point where sometimes I don’t give a shit. I start to disconnect from my patients, because of the overflow of shit I get to see everyday combined with the pressure from nursing adminstrators and low staff levels where we barely handle the normal routine staff all day in, all day out.  You see this shit all day long and ask yourself, why am I doing this? Is there an end?

Friends of mine tell me, your work is great, your work affects and help people directly and you can see the effort….I’m just a paper pusher and never get to notice the people I work with.

The days where I agree with this assumption of my friends…are getting rare.

Time to tranfer out!

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