Vaguely Nurse-ish

In which I let the wrestling gerbils out to get some air

Well, I say it at parties, and on census forms, and as you see, it’s even pretty prominent in my blogging profile. I’m a nurse. I’m a registered nurse. Rosie Bonner, RN. And it’s true. I am. I went to nursing school (graduating with my BSN summa cum laude, thank you very much) and passed the nursing board exam (the NCLEX) and got a license with a license number. I can take a blood pressure and give a shot, and I know what a SOAP note is and how it differs from a DAR note.* But I can’t help but feel like I’m lying a little when I claim the status of nurse.

For one thing, I haven’t touched a patient in years. My last few jobs have been of the administrative/research variety. I actually only worked clinically for a year after graduating from nursing school, in a geriatrics clinic affiliated with Fancy University (the same university where my husband Pete used to teach, but he’s in the humanities, so that was mostly coincidental).

For another thing, I never was a hospital staff nurse. I never (with the exception of my rotations in nursing school) took care of hospitalized patients, passing meds and hanging IVs and hurrying around in rubber-soled shoes and scrubs with a stethoscope around my neck. And that’s not nothing to nurses. For nurses, being a hospital staff nurse is paying your dues, and there are those who will never consider you a real nurse if you haven’t done it (or haven’t done it for long enough, or haven’t done it recently enough…). Of course, there’s a vocal camp on the other side, people who will earnestly reassure you that since nurses do a staggering variety of kinds of work, we are all real nurses, all of us important in our own special way. You know. Like that. The we’re-a-happy-rainbow people. And you know, I do kind of believe them. Politically, I more than believe them—I’m one of them. A nursing perspective is vitally important in outpatient care, in home care, in mental health, in public health… blah, blah, blah. But still there’s this irrational but nagging sense, and it won’t go away, that none of that is really real until you’ve proved yourself on the floor.

Finally, and probably most centrally, I hesitate because… because I’m just weird. I’m not like regular nurses. Personality, education. I’m geeky and wonky and grandly idealistic and big-picture-y (an ENFP in a nursing world of ESFJs, if you go for all that Myers-Briggs stuff). I went to a Seven Sisters college as a matter of course, and a lot of my friends are similarly Ivy-ish in one way or another. Which brings us to social class. I guess a lot of it is about social class. As Americans, we just don’t talk about social class that much—it’s not polite, I guess. After all, we’re a classless society, damn it. And as the Republicans have taken it upon themselves to define the terms of the conversation, just noticing that some people have more stuff and get more breaks than other people is tantamount to fomenting “class warfare.” But the fact remains that it was not surprising that I went to a Seven Sisters college; it took no triumph of will against unbeatable odds. I applied; I got in; my parents took out loans; I went. (Of course, all of this class stuff is relative. I arrived on campus thinking that I was upper-middle class because my parents went to college; I later learned from a classmate I was close to freshman year that she arrived thinking that she was lower-middle class because her family didn’t own horses.)

So to some degree, I think I will always feel like I’m “passing” as a nurse. I actually entered the profession in the first place with the intention of skipping over working as an RN entirely. I was going to go straight through in my nursing education to get a master’s degree and become a nurse practitioner. When I lived in San Francisco, in the early 90s, at both my paid job and my volunteer work, the primary clinicians were nurse practitioners, and I admired them fiercely. They were so medically knowledgeable, but at the same time so connected to the reality of their patients’ lives. They seemed like grown-ups. (By contrast, the physicians who provided clinical back-up and putative supervision to the nurse practitioners struck me as overgrown, high-achieving adolescents—protected and entitled and occupying their own little world.) So I decided that that’s what I wanted to be when I grew up. It was a little scary, because I’d always been a head person. I wasn’t entirely sure that I could actually relate to the physical world in any useful way. Volunteering at a women’s health clinic, though, I learned to take blood pressures and do finger-sticks and spin urine. Then, as I moved into an HIV-test counsellor role, I also learned to draw blood. It wasn’t much, but it reassured me at least that my hands worked.

I applied to the program they then had at UCSF for people with bachelor’s degrees in something other than nursing to become a nurse practitioner in three years (the first year to get the RN training, and years 2 and 3 for the master’s and NP certification). My application was rejected (reasons still unknown). I moved across the country to join Pete where he’d just started teaching at Fancy University, and ended up going to nursing school in that city. It was during the course of my nursing bachelor’s program that I sort of fell in love with nursing qua nursing. I ended up getting all flag-wavy about things like the primacy of the whole person over the (diseased) parts; caring as a central professional value; and nursing’s proud history of courage and altruism. I also learned that hospital staff nurse jobs were not the only ones available to BSNs, and decided to take a bit of time away from school before continuing on to get my master’s.

For my first year out of school, I exhausted and discouraged myself working at Fancy University’s geriatrics clinic, where I was the only nurse on site (not an ideal situation for a new graduate, to say the least). The physicians all had young children at home and so were out the door by 4:30. I would work late every evening, calling patients about medications and lab results, and doing paperwork. Phone calls can take a long time with elderly patients (Mr. Williams? IS THIS MR. WILLIAMS? SIR, THIS IS ROSIE, THE NURSE FROM THE CLINIC. I’M CALLING ON BEHALF OF DOCTOR NELSON. HE WANTS YOU TO STOP TAKING THE DYAZIDE. THAT’S YOUR WATER PILL… YOUR WATER PILL. RIGHT. THAT’S THE RED AND WHI… NO, SIR, THAT’S YOUR SUGAR PILL. YOUR WATER PILL IS THE RED AND WHITE ONE… RIGHT. NO, STOP TAKING IT…), and I’d work until I was so hungry and tired that I was about to cry, at which point I’d drag myself out the door feeling terrible and guilty about the fact that there were still a stack of phone calls to be made. I did like the interactions with patients. Some of my favorite moments were when I had a scheduled appointment to do foot care, during which I could take some time to chat with folks while I was shaving their calluses and cutting their toenails and rubbing in lotion. I liked the simplicity of it, the humility of it, and the basic human connection involved. I liked how straightforward it was, how it gave me a little break from my nearly constant self-doubt, how genuinely I could be of service. Sometimes the person would do a little half-dance after I was done and exclaim how much better her feet felt without the corns digging in. But it wasn’t enough to keep me sane. When a friend who worked in the Chairman of Medicine’s office called me to say she was writing a job description for a new position and basing it on me, was I available?, I said “No, really, things are getting a tiny bit better at the clinic, they really… um… what is it?”

Since then, I haven’t taken care of any patients. I’ve done asthma information sessions at supermarkets and health fairs and a nationally notorious public housing development. I’ve done focus groups with nurses about their relationships with physicians, and vice-versa. I’ve written small grant proposals and helped to write big ones. I’ve written newsletters, chaired subcomittees, done surveys, participated in grassroots health groups. I’ve soothed and flattered the cranky and the defensive; I’ve stuck up for myself and for others with the arrogant and oblivious. Occasionally I’ve led the way good lady ballroom dancers can if they have to, facing backward, appearing to follow.

But the fact remains that if the question is, “do his lungs sound wet?”, or if a catheter needs to be inserted, or if a dressing needs to be changed, then I’m not your gal. In fact, I feel nearly as blithering and all-thumbs as I ever was. And that’s not what nurses are. Nurses are brisk and efficient and capable and practical. Nurses know how. I know intellectually that it’s a matter of training, of experience, of practice. But it truly feels as if it’s part of a person’s identity, just part of who she is. And that’s what tells me I’m not a nurse. I go back and forth about this in my head over and over, the thoughts and feelings cycling almost predictably, like gerbils rolling around wrestling.

So this is where I am now. I have come to a decision that is not one I ever expected to make. I am going to be a hospital staff nurse. Not forever. For a few years. It might kill me—it is true that in some ways I’m supremely unsuited to the work. I’m by nature ruminative, and I’m really only comfortable if I have a thorough overview of a situation before taking any action at all. I don’t very much like being busy-busy-busy—it makes me feel harried and jangled and as if I must be missing something important. But I’m going to do it. Starting in April, I’m going to take a nursing refresher course (there are a lot of them out there now—I admit that there are things about the nursing shortage that I’m grateful for) so that I can improve my clinical skills, and then I’m going to get myself a job taking care of hospitalized patients. I will be one of the ones listening to breath sounds and putting in catheters and changing dressings.

And then I will know. I will have experienced the process from the inside, so that I can know whereof I speak as I spend the rest of my career trying to improve the process. I will store up a stock of insights and anecdotes and epiphanies. I will earn credibility. And though it is perhaps on the surface not a great reason for making a career decision, I will know that I can do it.

And I will let you know how it goes. It has occurred to me that writing regularly about the process will be an enormous help to me in getting through my first year as a staff nurse. (That and the Prozac, of course.) And for this, I thank dear elswhere, who a few weeks ago, on the phone, suddenly asked me, “if I set up a blog for you, will you write in it?”


* These are two standard formats for writing notes in medical charts, both taught in nursing schools. SOAP stands for Subjective, Objective, Assessment, and Plan; DAR stands for Data, Action, Response and happened to be favored at my nursing school.