Just a Nurse

I had a patient several times last week. The man was in his 60s, admitted for a heart rhythm that continued to come & go, despite several procedures and medications to stop it. So, after being at multiple advanced medical venues, he had been sent to UVA Hospital for further evaluation of what last-ditch-effort we could offer him.

Mr. Y was curiously normal. I'm used to patients with severe medical issues, and usually some accompanying mental issues... severe anxiety, depression, anxiety, control disorders, anxiety, massive trust issues, and ANXIETY. But Mr. Y had none of these things... besides this heart rhythm that occasionally made his implanted defibrillator go off, make him slightly short of breath, and generally drained his energy, he was totally normal! He didn't need to wear extra oxygen, have multiple medications to stabilize his blood pressure, or require dialysis to recover his kidneys. He just mulled about his room, reading newspapers and shaving his face and watching the building construction across the street. He was waiting for the procedure our docs decided was his best option.

The only two issues with this individual that I had to handle were his significant hearing loss and his apparent short-term memory deficit. I don't think he even really knew that he had a short-term memory problem, but after caring for him for 4 days and having essentially the same 5 conversations with him again and again, it became abundantly apparent to myself and my staff. His room was near the nurses' station and the break room, so anyone not in another patient's room would hear us repeat one of these 5 convos LOUDLY (hearing loss to the degree of needing to sit 6 inches from his "good" ear or kindly yell at him from the end of the bed).

*My co-workers, jokesters that they are, made many comments like "deja vu?" or "50 first dates" or "memorized your script yet?". Humor... it gets us through many 12-hour shifts.


The conversations we'd have over and over again would mostly pertain to the upcoming surgery, why his heart wasn't responding to normal therapies, or what other options he'd have if the surgery didn't work. Because these require extensive explanations, and because he was so hard of hearing, I would usually sit next to his bed to explain them to him. After any of these conversations, as I was about to leave to do other work, we would nearly always have this conversation:
Him: Thank you so much for explaining that to me.
Me: No problem. I hope you understand it better and feel more confident about the plan.
Him: I think I do, thank you. You did a great job explaining it to me.
Me: Well I have to explain this stuff to patients all the time, so I've found what works and what doesn't.
Him: Have you thought about going to medical school?
Me: No-- I have no desire to be a doctor.
Him: Really? I think you're too good to just be a nurse. You're wasting your talent. I think you'd be a great doctor.
Me: I think you think that because I sit down and explain things to you, make general conversation with you, and help you with little things.
Him: Exactly! If other doctors were like you, they'd be great!
Me: But I can only do those things because I'm not a doctor-- it's my job to do stuff like that with my patients. My job lets me focus on just you and one or two other patients, but our doctors care for a lot of patients, so they don't have time for that.
Him: Well I think you're wasting your talent. You're too smart and nice to be a nurse. It's a waste.
Me: I don't think I'm wasting it at all-- clearly I can use my understanding of this stuff to break it down for my patients-- and that's a worthwhile use of my talent!
Him: I think you could do better for yourself.

*I had this near exact conversation with him several times, but the last few times I would just say "I like being a nurse and never want to be a doctor" and basically change the subject... I can only be accused of "just being a nurse" so many times...

He was trying to compliment me. Or encourage me. Either way, I'm not offended by the interaction at all... just very disappointed that this is the way some people view doctors and nurses. As if all nurses had the goal of becoming a doctor, but fell short because of lack of money or lack of motivation or lack of intelligence... that all nurses were lacking. I wish I could send out a massive Public Service Announcement that made this point abundantly clear: Nurses go to Nursing School; Doctors go to Medical School. Two different schools... two different curriculums... two different goals... two different JOBS. Of course there are areas of overlap in what we learn-- we both have to understand the body and how it reacts to disease and medicines, we have to know medicines and how they interact with each other, and we have to understand the fundamentals of law/ethics/cultures as they relate to medicine.

But being a superb nurse doesn't mean I'm just a stone's throw away from being an MD any more than being a mediocre MD means you might as well be a nurse; it's a different job altogether! And the things that make me a good nurse often wouldn't translate well into a job as a physician. Can you imagine if I spent all this time explaining things to patients over and over again, for each of the 17 patients I'm in charge of that day? There's already a shortage of healthcare providers and appointments, and that is with very efficient doctors and nurse practitioners guiding it! Or if, in my preparations for morning patient rounds, I notice that one patient has urinated on himself and I took the time to give him a full bath and change all the sheets on his bed? I'd never get my act together in time for morning rounds! And that would hold-up the discussion and planning for the very patient I was trying to help! What if for every concern expressed about lack of insurance, expensive medications, the awful food, or difficulty getting up the stairs at home, I made a phone call to the social worker, pharmacist, dietician, and physical therapist. For each patient? Everytime I interacted with them?? Medically, nothing would get done!

There are just under 1 million doctors and approximately 2.5 million nurses. This is a legitimate ratio-- the nurses need to be more abundant because of all the minutiae we handle while the doctors' primary role is to handle the "big picture" and give orders. Both of us are problem-solvers, require creativity and ingenuity, necessitate skills in prioritizing and delegating, and must be compassionate to some degree. But we focus our efforts in different ways.

Remember back to being a student and having a great teacher. What made them a great teacher wouldn't necessarily translate into being a great principal or adminstrator. Their charisma, organization, and availability to the students are amazing attributes for teachers, but there are other priorities for adminstrators. It's natural for some teachers to take the path of eventually becoming an adminstrator, but I bet you could talk to any principal about their early months in that new role and hear about how their great teaching strategies didn't immediately "translate" into being a superb principal... different skills had to be developed to achieve that!

I'm slowly on my way to getting my Masters in Nursing degree. I'm pursuing it for many reasons-- while I love my job now, I recognize that I can't maintain this lifestyle for 20 years. What will I do that's still challenging and rewarding when that day comes? Having my MSN will prepare me for more options (unit nurse manager? transplant coordinator? patient educator?). I also recognize that one of my skills in nursing is that I can explain things to people easily. I would love to translate that skill into being a clinical instructor and help prepare future nurses! I need my MSN to (officially) do that.

The first time I had that conversation with Mr. Y, I had just found out I'd gotten into my first graduate nursing class. I was elated! And then I had that conversation with him, and the distance between his mind and mine felt immeasurable.

I want to invest in this field, and he thought I should abandon it entirely. But wouldn't that be a waste?