Why are nurses bitches?

Wellllllll.......(content warning: suicide)

The other day, a trauma surgeon and I were having a lively discussion about whether hangings meet criteria for trauma activations. See, back many, many years ago when trauma criteria was a new deal and lists were being made, a lot of hangings had cervical spine injuries and vertebral artery dissections. These are interventions that have a high probability of requiring surgical interventions, hence the need for trauma team activations. This is because many of the hangings studied were judicial, which is a fancy way of saying “executions.” There was certain way the noose was tied and there a significant fall prior to the noose “arresting” or stopping the fall, which had a much higher chance of death or causing the kind of injuries that require surgery. Most of us will never see these kind of events.

Suicidal hangings tend to be much more common and not performed from a significant height. This results in much less “trauma” to the structures in the neck, and injury/death occurs from asphyxiation; or suffocation. In this respect, I told him, they were much more like a drowning, something that isn’t a trauma activation. At which point, he said, “well what if I strangle you? Is that traumatic?” (Note: we have a good working relationship!!! This was not threatening or uncomfortable!) And I said “I don’t know, are you buying me dinner first?” And he just shook his head, and said “ER nurses. They always have something else to say.”

Which brings me to a question I have been asked before, by other medical people. Why are ER nurses SUCH BITCHES? 

I can’t speak for everyone, but I’m pretty sure that was my baseline personality prior to nursing, and why I ended up in the ER. Those who make it more than a few years in this specialty, be it doctor, nurse, CNA, or medic, have some very similar personality traits. 

First of all, most of us are pretty smart. I’m not going to expound on this or insist upon it—it’s my personal observation. You’ve got to have a big brain to store all the critical care drips and lab values as well as know every kind of splint one could imagine. But while we’re very smart, we have very “big picture” oriented brains. We’re not organized like the ICU brains. Show me an ICU nurses neatly labeled assignment sheet and I’ll show you the pile of post it stickies marked with things like TROP REDRAW AT 3 written underneath a random phone number with no name beside it. 

Second of all, we love chaos. We might tell you we don’t. But we do. On days when the tracker board shows open rooms and the most exciting thing that happened was a trimalleolar fracture that needed moderate sedation for reduction, our eyes are glazed and our movements robotic. 

But when the call comes in from an EMS battalion chief that says there’s been a mass casualty accident and multiple inbound trauma patients, that adrenaline hits. (DISCLAIMER: this does not mean fatalities in our lingo. It means that there is some sort of incident that requires all resources and hands on deck.) Everyone snaps into motion. Any patient occupying a trauma bay is immediately moved to a hallway or different room. The lab is notified to prepare emergency blood products. Rapid infusers are primed with saline and ready to start massive transfusions, chest tube trays lined up, glide scopes turned on, airway boxes opened and intubation supplies prepared. Trauma surgeons and residents arrive, along with respiratory therapists, anesthesia teams, OR nurses. We love that shit. We don’t want anyone to ever be hurt, but dammit, it’s going to happen so we might as well the ones to fix it. 

Third, we have a brain that goes straight to mouth. A regular person says, do you think this might have some complications or extra steps that aren’t necessary and will create extra problems? An ER person says, that’s the dumbest thing I’ve ever heard of. We don’t do extra words much. We spend a whole lot of energy saving lives and have little to waste on small talk, beating around the bush, all that. 

And also, along with being very direct, we are very fast. We’re the kids in school who rushed through our assignments all at once to get them done, so we could do fun stuff. We want to get from Point A to Point B with no bullshit. We don’t have time to waste—we have a full department and we never close. 

Another weird thing, a lot of us have ADHD. It benefits us in our environment because we jump from emergency to problem back to emergency and there’s no real plan. We roll with it. Everything happens in a short period of time. We’re great at getting a chest pain worked up and sent to cath lab or admitted in two hours, we suck at remembering things like turning up the tube feeding six hours from now.  We know Rocephin and Zosyn are the first line broad spectrum antibiotics but we can’t tell you shit about what antibiotics are for ventilator acquired pneumonia or deep vein prophylaxis in post surgical patient other than maybe it’s got something to do with Lovenox and those leg squeezy thingies. We know what to start Levophed at but we have no idea if it’s compatible in a line with Propofol so we’re just gonna throw a central line in. 

I know that there are medical people who have met me in the course of the hospital that probably think I’m a bossy bitch, but I’m actually super chill when everything’s going well. The times when I’m seen as bitchy, is probably not me actually being bitchy. It’s because in the ED we say things like “I mean, are we gonna tube this guy or let him aspirate? Just a question.” So when I come to another area I’m actually being super nice when I say “this guy needs intubated right now he’s not protecting his airway so who’s doing it?” Yes, I’m ‘just’ a nurse. But in my area it’s about two minutes from a decision to intubate to the person being intubated. So rather than calculating a GCS (hint—in airway management you only need to know if it’s less than 8) and talking about possible causes of the decreased level of consciousness, I’m doing everyone a favor by cutting through all talk to the decision. Also, sometimes the ICU nurse and the house supervisor are thinking all the same things I am but they have to work with the people in the room a lot and I’ll probably just see those people in passing where they’ll pointedly ignore me so stepping on some toes doesn’t bother me. 

Women who are assertive are sometimes viewed as aggressive. Most ER nurses are women, though we do have one of the highest percentage of male nurses, and we’re mostly all assertive. So maybe what comes off as bitchy is that Kamala Harris type of “I’m speaking. I am speaking.” It reminds me a time when we had a trauma patient who was altered and thrashing around quite a bit. Our trauma surgeon asked his brand new resident what our next steps were and he said he didn’t know. I said I had some suggestions and the trauma surgeon said like? And I responded “we gotta get him to the scanner to look for a bleed and we can’t take him like this so let’s tube him, and get to the scanner.” And he was like “yep.” Now I’m not a doctor, and I don’t pretend to be one. They’re way smarter than me. I could never have passed the MCAT. But I am an experienced nurse who knows her shit. It was a great experience for the resident—listen to your experienced nurses—and for me, because the fact that my voice was important too was validated. That resident was chill. I’ve met others, and doctors, who had more of, ‘I am the doctor, you are the nurse, you just follow my orders and know your place’ experiences. When I feel very strongly that the patients needs aren’t being met, its my responsibility to advocate for those needs to be met. Assertively. Again, which comes off as bitchy, sometimes. 

We’re also all very no nonsense. We’ve seen a lot. We’ve done a lot. We have a goal in the ER: throughput. Also known as disposition. No one is supposed to stay in the ER forever. Our job is to diagnose your problem and get you where you need to be, whether that’s home with a fancy splint, to the OR for emergent surgery, or to the ICU where the really smart people can not only save your life but figure out how to keep it saved. We absolutely know Grandpa can’t live on his own anymore. We hear you. And we will admit him for failure to thrive or weakness or anything we can come up with to get you all some help and access to social work and case management services. It’s not that we don’t want you get that help—we don’t know how to do it and don’t have the resources to spend the time doing it. We’re gonna get you there, though, I promise.

But don’t you guys have feelings? I’ve seen you walk out of a horrible trauma and go right in like nothing happened?

Of course we have feelings. In fact, a lot of us carry a lot of trauma inside. I would go as far to say the majority of us have some form of complex post traumatic stress disorder. But having feelings that cause a breakdown doesn’t help that woman in the other room who needs pain medication and emotional support during a miscarriage. It doesn’t bring up the low blood pressure of this patient or help that one to the bathroom. So yes, we have feelings. I once sat on the floor for over an hour with a patient suffering severe depression who did not believe her life was worth living just to show her that someone cared. Even though I was hungry and hadn’t peed in eight hours. Because that was more important. I have cried holding a grieving mother. I have gone into the bathroom and cried before going with a doctor to deliver bad news. I have gone home and been unable to sleep because I couldn’t stop thinking about something that had happened. I have left work feeling fine and been hit by a tornado of emotions and pulled off to the side of the road to cry. Sometimes there isn’t time to have feelings at that moment. Sometimes feeling my feelings are detrimental to others and it is my job put them away to unpack later so I can be of use at that moment in time. 

I have patients and families I’ll never forget, whose experiences are a part of me.

Also, we’ve all been verbally abused and physically assaulted by two years in. Once a patient told me they were going to kill me and rape my dead body because I had to perform a blood draw ordered by a search warrant. So it’s kind of hard to hurt my feelings by calling me a bitch. There will be another post about violence against healthcare workers in the emergency department later. Just know it’s a little hard to have those things thrown at you and still be Suzy Sunshine. Some people manage it. I’m not sure what magical thing resides in their soul but I’m jealous. 

In summation, we’re not bitches. We’re dedicated and passionate healthcare workers who want the very best for our patients and don’t mind being called bitches if it gets shit done for the patient. 

A postscript—also we drink a fuckton of coffee and energy drinks. 

Another postscript-we are not grossed out by anything. Once someone came to get me because they thought they saw bedbugs. Turns out someone had suctioned maggots out of a wound, thrown the suction canister along with some bloody stuff in a biohazard container, forgotten about it, and as it turns out they had....reproduced a lot. I walked in the room calmly munching some BBQ chips and said “oh yeah those are just a LOT of maggots.” And finished my snack. 

Love, your friendly neighborhood ER nurse.