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Nursing stopped being patient care and more paper work. It use to be fulfilling work but when I retired they were wanting to give you a time limit for each patient that included the paperwork. You couldn’t even give a proper assessment. I was lucky to be in Hospice but we HAD to take our time and our paperwork was double to what regular nurses did because we had to do pain evals , skin assessment , med evals , talking with family members and most importantly letting the patient know how important they are and will always be. You would be surprised at how many family members abandon Their relative until after they pass and then they are the ones that has all the guilt tears. One of my most memorable ladies was one of my Nursing professors . So well loved and not one person visited near the end to say good-by. I ask her one time when I had cancer and she was the nurse supervisor (she talked me into nursing) that every day student nurses took care of the patients but she was the one that always took such good care of me and why I NEVER had a student. She looked at me and said “ Oh Shirley, you were Hospice and not expected to make it .“ I never knew until God healed me. She helped me get into the Nursing program. I then did what God had wanted me to do all my life and never listened.

What do you think of it?In almost three decades as a nurse, I have had patients say a lot of surprising things, but this one left me momentarily speechless.It was summer, and summertime meant no one was having heart attacks. I don´t know why, but every summer our census dropped, and we had almost no patients in the ICU. That meant we were overstaffed and instead of sending us home, we got “floated” to other areas of the hospital.I was floated to the cardiac floor and was getting report from the outgoing nurse. She had told me about five of the six patients I would be taking care of, and she began telling me about the last one who had just arrived from the ER.“64-year-old female, complaining of chest pain. EKG looked OK; we are waiting for her labs to come back.” The nurse leaned closer to me. “She doesn´t have any family, but she has a friend with her, whom I suspect is more than just a ´friend´.” She lowered her voice. “I think she may be a lesbian. You may want to watch that.”This was during the time that AIDS and homophobia were both rampant.“Okay.” I said. But inside I was doing a huge eye roll. The month before I had taken care of a death row inmate in the ICU who had raped and murdered over twenty women. If she thought I was going to get my panties in a twist over a lesbian….I went to see the patient. She was a pleasant woman, and I introduced myself to her. She denied any more chest pain and I made some small talk to determine if she was oriented to person, place, and time. We seemed to hit it off pretty well, and after securing her permission to examine her, I started.I shone a light in her eyes and listened to her heart and lungs. Checked her pulses and skin, listened to her belly, and kept going down. She had some problems peeing in the ER and they had inserted a urinary catheter. I lifted the sheet and checked the catheter. Everything looked good. I continued down her legs, pulses, skin, and strength tests.She was fine. I was about to check her vital signs and get ready to move on to my next patient when she suddenly said, “What do you think of it?”I stopped. “What do I think of what?”She smiled. “What do you think of my vagina?”Whaaat? My brain screeched to a stop. I had never had anyone ask me that. How do you even answer that question? The other nurses´ assessment of her sexual orientation came to the forefront of my mind.Was she hitting on me? I found it implausible that a sixty-four-year-old woman would try to hit on her twenty something year old nurse. If that was her best pickup line, then it certainly needed work.“Um, it looks fine?” I said hesitantly.She smiled broadly at me. “I bought it ten years ago in Thailand.”My mouth dropped open in shock and I stared at her like a hooked fish.I realized I had to regain at least some semblance of professionalism, so I shut my mouth and tried to wipe the stupid look off my face.“Uh, wow, I mean, um, wow.” I stammered out meaningless drivel.“Now that you know, take another look and tell me what you think.” She looked at me encouragingly.“Okay.” I raised the sheet again and gave it more than just a cursory examination. “I have to admit, if you hadn´t told me, I never would have known. Your surgeon must have been incredible. It really is a work of art.”She smiled happily and nodded. “Dr. *Srisuk is amazing. He´s like a sculptor or an artist.”“The Van Gogh of vaginas.” I blurted out before I could stop myself. I clapped my hand over my mouth and looked at her, hoping that she didn´t think I was making fun of her.She looked at me, her eyes widening with surprise, then she burst out laughing. “The Van Gogh of vaginas! That´s fantastic. Do you mind if I steal your line?”I was just relieved that she hadn´t been offended. “Be my guest. It´s all yours.”After speaking to her more during the day, I discovered that her ‘friend’ was actually her wife. As in the wife she had when she had been a man. They had been married for ten years and had three children together before her transition, and then her wife decided to stay with her instead of asking for a divorce. She just never could introduce her as her ‘wife’ anymore.After her bloodwork came back, it showed that she hadn´t had a heart attack, just angina, so the doctor wanted to keep her under observation for a couple of days to get her regulated on some medication.After my shift was over, I decided to go to the hospital medical library and see if I could find out more about her surgery. In those days, transgender wasn’t “a thing”. In fact, I can´t remember ever having been taught the word in all of my college classes. The surgeries were only being done in a handful of countries, Sweden, Denmark, Thailand, and a couple more.Johns Hopkins, after having done one of the first in 1965 had stopped altogether in 1979, stating that they were “no longer going to enable a mental illness.” So that was the atmosphere when this event happened.I went to the library and couldn´t find any reference books on the subject. When I asked the medical librarian, I got the disapproving look. You know the look, honed from years of telling strangers to shush.“I don´t believe we have anything about that in my library.” She said primly.For those of you who are wondering why I didn´t just Google it, this was in the time when dinosaurs roamed the earth and the world was still black and white.OK, maybe not that old. The world had become color when I was around six or seven, but I am sure there were still some dinosaurs roaming.This was the Year of our Lord nineteen hundred and something, BG (Before Google).So, my only recourse was to find a reference book – written on paper.The horror of it all.I was floated to the same floor for the next two days and got to take care of her again. On the third day, the charge nurse asked me if I was okay with taking care of the patient in 502 once again.“Of course. Why wouldn´t I be? I have been taking care of her for the past two days.”She was personable, a walkie-talkie (what we called patients who can communicate and get out of bed unaided), and she had a nice, non-demanding family member.I had hit the nursing trifecta.“It´s just that there are quite a few nurses here that don´t want to take care of “it”, so I just wanted to make sure you didn´t mind.” The charge nurse said.I narrowed my eyes at her. “No, I don´t mind at all. And she isn´t an “it”, she is a she. Have you seen her vagina? It´s amazing!”

The There is an answer here, from a mom whose child was in the NICU, and felt the nurse responded inappropriately and wanted the nurse fired. This is what happened in our NICU, when a mom complained about “incompetent care” when unwarranted.There is a long back story.It was an isolation room that had two babies with the same “bug”, so they could be paired. Initially both babies were very ill, and each required a 1:1 nurse. These babies were both “preemies”, but one was a 32-weeker, and the other a 25-weeker. That’s a huge difference in size, physical organ maturity, and toleration of handling and stressors. Both babies came through the critical phase of the infection, and the older baby progressed from full respiratory support (ventilator) to moderate support (NCPAP) (nasal continuous positive airway pressure). The younger, smaller baby still required full ventilator support.Very young, very complex and very ill babies have a Primary Nurse, who looks after that baby on every shift. The Nurse not only becomes the complete historian for that baby, but quickly notices small differences in appearance, decreases in toleration, and increasing need for intervention. These are reported to the NNP and Neonatologist for follow up. In this way, many medical problems are identified early and appropriate treatments started. Also, when the same Nurse is at the bedside most of the time, a rapport develops with the mom/parents/family; the family trust the caregivers, and the caregivers extend emotional support (and more) to the family. It is a very beneficial arrangement.I was the Primary Nurse for the smaller, younger baby, who had many complex issues besides the isolation infection. He required consistent care from all disciplines, as he was progressing slowly and had many setbacks. A major event (NEC) was avoided by fast intervention at the earliest indications of symptoms. Mom was at the bedside daily, and we had great rapport. Her financial situation was not great, and I often brought lunch for her as well as myself on those long hard days, when she sat and silently cried and prayed while the monitors alarmed and the staff responded. Mom was so grateful for everyone’s care and attention to her very fragile baby.The other baby progressed smoothly. Her breathing improved, and was tolerating small amounts of feeding via NG tube. Her mother, was also a constant presence, but there was a difference. This mom found something wrong with every nurse who looked after her daughter. They didn’t respond fast enough to an alarm. They didn’t know all the latest lab values by memory. They didn’t arrange the toys in the isolette in the right order. They forgot mom’s ritual of kisses in the head, each cheek, chin them forehead, before returning the baby to her isolette after mom held her. (It’s a complicated process when the NCPAP, NGT, IV lines, monitor leads and baby all need to be supported) And finally - They didn’t bring her lunch(!). We professionally understood that mom was acting out in response to fear for her child; but it was tough to handle all the unwarranted criticism.The Nurses didn’t like working with this mother, as there was a major complaint about a minor issue almost every day. The baby’s Primary Nurse asked to be reassigned- so that baby always had different nurses. Until, the older baby progressed so much that the pair became a 2:1 assignment- a very heavy assignment. My assignment. Every shift. The babies harboured the same infection, but a different isolation gown / mask / gloves were required for each one.I tried so hard to appease this mom. Memorised lab values. Had things for ready skin-to-skin holding before she arrived. She complained that I paid more attention to the other baby (still on a ventilator and multiple medications). That I didn’t run to her bedside when an alarm sounded. The Nurse Manager advised me to try harder - not in baby care, but to keep mom happy. Mom, in effect, was the third patient in the room. I, and one night Nurse, were the only ones willing to go in that room every day.The day of the “catastrophe “.I was at the computer, charting. The computer desk was steps away from both beds. Mom was holding her baby while a feeding was infusing. Mom sneezed- a big one! But she said she was fine. Then her baby’s monitor started to alarm - bradycardia. I quickly stepped over, cleaning my hands and donning gown/mask and gloves on the way. It was obvious to me that the feeding tube had dislodged, and was at the back of the throat causing the bradycardia. More significant was the real risk of aspiration from the milk in the dislodged tube.I told mom exactly what was happening, pulled the NGT the rest of the way out, pinching to ensure no more milk dribbled out. I told mom that baby needed to get back in the isolette NOW to further assess her. Mom started her ritual kissing. I’m so sorry, I told her, baby needs to go back NOW, as she was visibly changing colour. Mom refused to let go and continued her ritual. I pulled my emergency alarm and the “troops” (Doctors, Respiratory Therapy, more Nurses) arrived immediately and baby was handed over. Mom stated that when she sneezed she accidentally pulled out the feeding tube, but shoved it right back in again, and thought it would be okay. Baby was X-rayed, started on prophylactic antibiotics and monitored closely for S/S of aspiration. Baby was fine, after 3 days antibiotics were stopped.Mom was not fine. She complained loudly that I was not sensitive to her and her baby. When the Nurse Manager and Neonatologist would not remove me from the room, she went to the hospital CEO. I was banned from the room - and my complex and critical Primary baby. Because of the infection issue, neither baby could be moved.Those two babies had different care givers all the time. The only nurse that mom tolerated was the relatively new one that would sit and chat with her. Her baby, older and more mature, progressed well and was on her way to discharge.“My” baby, deteriorated. Small changes were not noticed. Abnormal lab values not reported. Feedings not tolerated. The new nurse did not catch all the warning signs, was unaware of his history, there were no other consistent nurses, and this time the baby had full/blown NEC (necrotising enterocolitis) went to surgery and lost ⅓ of his bowel. He barely clung to life for weeks; then months. I was not allowed back in the room because of the other mother.Discharge home day usually is a celebration for the long term babies, with a cake and ribbons and “graduation” certificate. Complaint Mom’s baby had no party or celebration.I, 2 Nurse Practitioners, a Resident and 3 other Nurses were at the other baby’s funeral that day. Grieving with a family happens a lot. Going to the funeral - extremely rare.It didn’t have to end that way. The other mom didn’t have to lose her son in such a painful manner. At the funeral, sick baby’s mom thanked us SO much for all the care we gave to her and her son. We cried with her- and could never tell her WHY I had been suddenly reassigned.Jaevon would be 18 years old now. I still shed tears, remembering how one belligerent mother bore some responsibility for the death of another mother’s child.Just be cautious with your complaints!There is true negligence; there are also a lot of overwhelming unknowns and mysteries for the average person in the complex world of Intensive Care Units, Emergency and Operating Rooms. Communicate - Evaluate - Educate yourself; don’t just condemn.ETA:There have been many comments as to WHY this was allowed to happen. I still judge myself for not being more assertive. But, it was 2001 and things were different. Here is an answer (Sorry, it makes an even longer read) to these frequent comments:It was so terribly difficult. I have guilt feelings to this day. How could I have handled things differently on “catastrophe day?” I have no answer to that. HIPPA played a huge role in non-disclosure. HIPPA can be very good - or very destructive. This time HIPPA was the snowball that caused the avalanche of horrors.Complaint Mom went over the head of the Chief Neonatologist, and the Nurse Manager, to make her righteousness and entitlement known to the CEO. CEO, a woman, was new to this position, and teary-eyed mom convinced her of my disrespect towards her, in spite of input from the Chief of Staff and NM. Very very unfortunately, she came from big money, and a “big” family that had made significant contributions to the hospital. It’s ironic that while SHE was a daily presence, the father rarely showed up; the extended family only at admission. The Big Money prevailed. The other family used Medicaid and Welfare. In the USA - this matters a great deal. It can be a death sentence. It was for Jaevon.While the Executive Branch barred me from the room - with the threat of termination if directives were not followed - it did not prevent the emotionally invested staff to eek out the best care for the little fragile baby - who was at the opposite end of the social-economic scale. By law, I could not even access Jaevon’s lab results or X-rays. My signature entry codes could be traced. Others would put them on the screen for me, and then be busy elsewhere. In this fashion I could clandestinely alert the NNPs to warning signs. I could meet mom in the parent lounge, and give her a bag lunch with a note inside. All I could tell her was that I needed to be reassigned for the good of the unit. The NM had immediately assigned me as a Preceptor for a new staff member, and that would automatically exclude Jaevon. Mom took it with grace. If it ever got back that I had been reassigned due to the complaint of the other mom - I would have been terminated. And, the general NICU staff could not even be informed of the directive.Standing up for patient rights is a Nurse’s forte. Doing so, at the expense of ones own children, is another matter. I had too many mouths to feed at home.In highly-stressed, highly critical areas of Nursing, there are also lots of Type A personalities, and huge egos. One must tread lightly in offering advice to the Nurse in charge of a particular patient. Unless there is obvious negligence- it never goes down well for the informant. The Neonatologist must also be aware of his sources and credibility. Since the CEO deemed me “non-persona”, he had to collaborate everything I told him, and cite a different source.It was an excruciating time - for me, for the staff-in-the-know, and especially for Sick Mom. But she held up better than any of us.I still ask myself; WHY did this happen? HOW could this happen? We were ordinary folks, doing our best with what we had. HIPPA, big money and big power prevailed. It’s not a good answer. It’s not a comfortable answer. Everyone who was involved with Jaevon, will never forget him.Sure, because of all his co-morbidities, he needed a miracle to survive intact. The Miracle eluded him. But I believe that mom would have cherished any bit of that baby to take home and love.Throughout my years in the NICU, as one of the nurses who was assigned the smallest and the sickest, I lost 56 Primary babies. 16 in one year. I only went to 2 funerals. Jaevon, I’m sorry.