By Debbie Moore-Black, RN

He was Ivy League. Med school. His dad was an MD too. They lived not to far from this small cliquish town. Daddy’s house was right around the corner. That “mini” mansion.

After successfully completing his residency, Dr. David became our ER physician. This was a big deal. A big fish in a little pond.
He had an aura. He easily smelt of money. He also had an arrogance about him.
Though he was new to our hospital, he would definitely be the top dog. Anything he told me to do I knew I had to comply.

I loved ER nursing . I was still an LPN working actively on my RN.

Us LPN’s know our place. We know our hierarchy. And I knew my place. I was there to serve, honor and obey.

I couldn’t wait to be an RN. Because as an LPN we were so limited. And I wanted so much more.

It was a Saturday. Around 0230. A young man came stumbling  into the ER. He was obviously intoxicated.
We sat him down on a stretcher. He had that disheveled look. Dehydration.
Dr. David ordered stat labs. The phlebotomist  came in and drew his labs.
The patient had an obvious look of electrolyte imbalance.
Low blood pressure. Heart palpations. Muscle twitching. Nausea, vomiting and diarrhea. The EKG monitor showed ST depression and prolonged PR intervals. A few PVC’s also.

And just as Dr David predicted, this patient had a dangerously low potassium. K+ was less than 2.4.

Dr David knew I was an LPN. But it was just me and him in this 6 bed ER. So whatever I legally couldn’t do, he would have to do it.
He drew up some potassium from a vial. I assumed he was going to mix this in a mini bag.
I was certified to start IV’s. And so I did. LPN’s were never allowed to give any medication IV push though.
Dr. David never put the KCL in a mini bag. He had the KCL in a syringe and he ordered me to give the potassium IVP.
He said as long as he watched me I could do it.

In front of the patient, I told  Dr. David that we could not give this patient KCL IVP (potassium chloride IV push). And he said then he would do it himself.
I became frantic. And in a firm voice I told Dr. David “you can not give a patient KCL IVP. You will kill this patient”. Dr. David got the syringe and put it into the IV port. He was getting ready to inject into this patient. I immediately squeezed the tubing in half. So the KCL couldn’t go through. And I repeated myself “you cannot give the patient KCL IVP.
It will stop the patient’s heart. You will kill the patient”.
Dr. David stopped. Starred at me with his glaring eyes. And said “fine, have him admitted to the medical floor. Let those Doctors deal with this patient”.

This was in the late 1980’s.

I learned a valuable lesson that night.
That whatever hierarchy ladder we stand on in healthcare, we all have a responsibility. A responsibility to ourselves, to fellow healthcare family and most importantly a responsibility to our patients.
Knowing that I was only a rung on this ladder…. But had I not spoken up and bent that IV tubing…. That patient would have most likely died.
Dr. David was angry that I defied his authority.

Arrogance sometimes can be quite dangerous.

Today, 2022, the NC Supreme Court ruled that nurses can be held liable for medical errors or mistakes- even if they were carrying out the Doctor’s orders.

Racial disparities in nursing

By Debbie Moore-Black, RN

I could give you several examples of racism that I have witnessed in my lifetime of nursing.
But there is one incident that always rears its ugly head.
Her name was passed down to her from her great great grandmother.
Her name meant “God’s promise”.

Olisa came from a long line of nurses. Her great great grandmother was a nurse/nanny/slave owned by some wealthy folks on their Southern plantation.
But the torch was passed on in her family for the love of nursing; one generation to the next.

Olisa was bright and funny and the first in her family to earn a BSN.
Tears from the entire family upon her graduation. Nursing cap, diploma, stripes and the Valedictorian of her nursing class.

Growing up, Olisa always knew she would be a nurse one day.
After graduation and passing her NCLEX exams with flying colors, she entered into a Residency program for new nurses who wanted the speciality of Intensive Care Nursing.

This was an aggressive, high acuity ICU at one of the best hospitals in this southern state.
Olisa loved nursing but through her journey in nursing school, it was the ICU that captured her.
Her dream of helping to save lives, to identify, report and implement the warning signs of a crashing patient. Of multi system organ failure.
Olisa was good and caught on immediately. The staff loved her. The ICU physicians loved her. The Respiratory Therapists knew that when she was on duty, it would be a good night even if it was the night from hell!!

After one year, Olisa was asked to be a charge nurse. With that came many responsibilities. Not only was she responsible for the nurses and their patient assignments, she had to be stellar in her skills and in the policies and procedures of this critical care unit.

For three years she was the charge nurse/staff nurse. She carried her name and her profession proudly. In honor of her family filled with generations of nursing.

Olisa decided she was competent and worthy to climb the corporate ladder in ICU and so she applied for an ANM position. (Assistant Nurse Manager).

But there was a new strange aura in this ICU.
New nurses replaced the vintaged experienced nurses. Management had sadly changed hands many times.
And her interviews for the ANM position were being stalled and then cancelled. And Olisa received explanations of “we are looking for someone from the outside.”
Or “we need someone with more experience.”

The excuses came one by one with upper management, and then she noticed her assignments along with her doing charge nurse had changed.
She now was given 2 dangerously high acuity ICU patients. Frequently. Somehow the camaraderie was lost on this team.
And then the whispers came. The degradation. The ethnic name calling. Intimidation.
The snide chants of “Go back to Africa.”

And as an accomplished and well respected ICU nurse that she had earned over and over again, suddenly she was being questioned and second guessing by her younger staff and by upper management. Even the patients and family members seemed to express this negatively toward minority nurses.

Olisa knew something was wrong. But she asked some of her other nurses she had known from her mentor program were they experiencing the same?
Interesting enough, there seemed to be a higher percentage of disrespect and disregard to nurses of color and ethnicity. Hispanic, Afro-American, Middle Eastern countries.
It was obvious that these minorities faced discrimination.
Leadership and mentoring promotions were denied.
And though the nurses not only went to upper management, they reported their findings to HR (Human resource department).
A blind eye and disregard was blatant.

Olisa knew it was time to be proactive.
After interviewing at several different hospital systems, she chose a progressive hospital system that encouraged diversity. Equality. And inclusion.
She sadly left what she thought would be her “professional home.”

And within several months at her new institution, her career blossomed. She became her positive and professional nurse that she always was. But because of the moral decay of the previous institution, she almost lost her way.

Olisa. “God’s promise”. She held her head up high. And honored the generations in her family that carried the torch for nursing.
She was proud of her accomplishments. Well earned and well deserved. Stellar.
And that shining star that she was and is could not be dimmed.

Seemingly unimportant acts make a big difference

By: Debbie Moore-Black, RN

We were reminiscing recently at a brunch we set up. It had been many years since we had seen each other. Eventually, we went our separate ways. But we reconnected once again.

Anna was one of our night shift nurses. She was bright and articulate. She eventually became a preceptor and mentor to many new ICU nurses.

The “night shifters” are on an island of their own. We form a special family, camaraderie and trust with each other. We are a special team.

Our ICU was a 24-bed, high-acuity unit — all beds full.

Each patient had their own diagnosis. But beyond the diagnosis was a person and beyond that person was a family.

Anna took care of a 42-year-old female. Last ditch efforts were made to save her life. She was young with a husband and two children.
The patient sadly was diagnosed with metastatic breast cancer.

Eventually, the patient had to go on the ventilator. Her BP dropped dangerously. She had a central line inserted and added IV drips of Levophed and vasopressin.

Anna was at her side. And so was the patient’s husband, Jeffrey.

Jeffrey came in every night to be at his wife’s side. He held her hand and talked to her. He read to her. Poetry, the Bible, talked to her about their two small girls. But his wife lay there deteriorating. Jeffrey knew the outcome was dismal.

Faithfully, every night, he slowly walked through that ICU door.

And every night, he was greeted by Anna, RN.

“Hello, Jeffrey,” she’d always be there to say hi to him. She’d stand by his side as he sadly looked at his wife.

It was a slow shuffle every night for two weeks. But Anna was always there to greet Jeffrey and talk to him. And she would smile at him with her caring eyes.

Because we all knew the truth, we all knew this young lady was not going to make it.

Jeffery spoke with the physicians and with Anna. It was futile. With breast cancer that ravaged her body, they made her a DNR. She was extubated, and we all provided her with comfort. We made sure she was not in pain.

Jeffrey knew the time had come. The day he woke up and felt his wife drifting away.

He made his last walk through the ICU to see his wife one more time, to hold her hand one more time.

And there was Anna to greet him. Her smile. Her caring eyes.

Jeffrey said his goodbyes to his wife as she drifted away. Her slow agonal breathing. And then her final breath. The EKG with a straight line. Cancer had taken her life.

Jeffrey sadly walked toward the ICU door to exit. But on his way out, he stopped to talk to Anna.

He said to Anna:

“Every day, I came into this unit, and you said hi and called me by name. There were days when that was the only good thing that happened. I wanted you to know that. Thank you.”

And then he walked away.

Anna burst into tears.

As we drank our coffee at this restaurant, tears rose in Anna’s eyes.

She told me how this defining moment in her ICU career taught her an important lesson about the value of kindness. And how simple, seemingly unimportant acts can hugely affect the people around us.


Also Published at KevinMD.com

He was more than a housekeeper

By: Debbie Moore-Black, RN

Over 30 years ago, this man began working for our hospital system.

He was assigned to our ICU/CVICU units. Though some health care employees hadn’t even been born yet, Charles was a tried and true “lifer.”

He was our housekeeper. And he was our friend — our family.

He was a man with energy and stamina. He was a hard worker. Relentless. He could spin circles around a pack of 20-year-olds put together.

His corny jokes and stories always put a smile on our faces.

He was always there for us no matter what. And though he came from the housekeeping department, he was a part of our family.

If he saw a nurse crying after her patient had just died, he was there to pat her on the shoulder and listen to her.

He easily talked about football with our technicians and nurses.

He was compassionate and kind.

But his health was failing him, and he put in for his retirement.

We loved Charles, and though we were sad he was going to retire, we knew he needed his rest.

Charles gave and gave. Though he never expected anything from us, it was our turn to give.

On his last day, we presented him with a room full of staff members to wish him well and three tables full of food.

We all put our hearts together and collected a cash gift for him.

As he joked and laughed with us, we presented him with a card we all had signed.

As he opened his card, his eyes grew big and started to water.

Charles was without words, and though he never stuttered, this time, he did.

He dabbed his eyes. He was speechless.

Although this is not a story of bragging rights, it’s a story of a family created at our workplace. Charles was a part of our family.

If you could have seen the look on his face, you would know that in this land of greed — where some must have the biggest house, the fancy car, the ultimate vacation — there is nothing that could ever compare to the look on his face.

This is the gift of giving.

I can’t tell you how it lifted our hearts to see the look on his face as he opened his gift.

There is nothing better than the act of giving.

Thanks to all that dared to care.

Charles passed away two years later.

I know he’s watching over us.

He’s undoubtedly our guardian angel.

Thank you for your unconditional love.

And for always caring for us nurses, doctors, and assistants.

Fly high, Charles.


Story published at KevinMD.com

The Country Club

By Debbie Moore-Black, RN

If mommie dearest only knew.

Here I was sitting in the banquet room. A room full of retired nurses celebrating with upper management. They were praising us for our retirement. Praising us for our blood, sweat and tears, massive overtime hours with little to none potty breaks., praising us for our missed time with our family like Christmas and Easter and Thanksgiving to name a few.

It was nice.

Waiters, with their white gloves serving us tea and coffee and a fine meal with adorable desserts on the side. Crystal chandeliers hanging above at each table.
A long termed chaplain to pray over our food.
A Senior Vice President cheering us on.

It was nice.

But maybe I’m what Prince use to sing:
Maybe I’m just like my mother… she’s never satisfied…
Mommie dearest use to call this Country club: “The blue bloods”
Dad moved up the corporate ladder. We had the big house. And the lake house and boat. And the private school.
What we didn’t have was the acknowledgment of alcoholism, as daddy eventually became a non-functioning alcoholic.
Mother would have done anything to be a member of this elite country club…

As this upper echelon group talked to us praising us, they interjected how we could volunteer to help the nurses in the hospital like give out dinner trays to the patients, assist in feeding some of the patients, assist in turning and repositioning patients…. And loads of other “opportunities” to volunteer for the corporation. The list was endless.

It was nice.

As they each gave their speech, my mind drifted off…..
How I was so tainted by several hospital systems. How I dedicated 46 years of my life to nursing. Emergency Department Nursing, Surgical/PACU Nursing, Surgical Trauma ICU, ICU, CCU, Behavioral Health Nursing…

Nurses week would come and go every year. And we were honored by a cookie, shoestrings, a rock, half eaten pizza, lifesavers….

I reflected back on all of my trauma and triumphs during this career.

Management attempting to write me up for calling out sick while my husband was dying,
because I had to call out sick frequently before leave of absence was initiated for me.

Mandatory overtime.

During Covid there was nurse desperation, while travel nurses were paid over $100/hour, we were offered an extra $5/hour… maybe.
My list is long.

There was sadness in my heart.
Sadness for the little old lady in ICU who lived on borrowed time but wanted to teach me how to knit. And so she did.

Holding the hand of a near catatonic mother as she starred at her dead daughter in ICU who had just plumaged 5 stories to her death.

The mother that called me relentlessly of her son paralyzed from the neck down. Drugs and no seat belt.

The little 6 year old girl brought into the ER. Long blonde hair with eyes black as coal. Catatonic after being molested by her momma’s boyfriend. While momma was out playing bingo. My heart shred as I still tremble inside.

Or the time a daddy that had a near fatal heart attack, but survived from a CABG and ECMO and cardiac rehabilitation. Survived in time to walk his pride and joy, his daughter, down the aisle on her wedding day.
My list is long.

I have survived any tragedy that comes with nursing.
The good nurses. The bad nurses. The bullies. The good management and the bad management.
I am a survivor. I am resilient.
But I am human.

Thank you for this fine meal.
The memories will always be engraved in my head.

I was escorted out to my car by an attendant.
A beautiful bouquet of flowers in my hand.
A lifetime of memories.
And yes…. I will “volunteer” for your corporation…. For $50/hour not including differential.

Mommie dearest would have been jealous that my final destination in nursing was…
The Country Club!!!!
It was nice.

When the glass slipper doesn’t fit.

By: Debbie Moore-Black, RN

I was raised in the 1950’s-1960’s. Our traditional family was the mom that stayed at home, cooked, kept the house clean, and dad who worked his way up the Corporate ladder.
He was a weekend dad.
And she was a trapped and miserable mother and wife.

I remember the storybook fairytales like Cinderella, Snow White, Sleeping Beauty, and later the Little Mermaid, and Beauty and the beast.
Eventually the woman in distress finds her male hero to save her day. To ride off with him on that white horse.
And I believed the fairy tales.

Towards the mid 1960’s-1970’s I was well aware of the women across the country screaming “women’s liberation.”
And I payed attention to this new unrest in our country.

I was raised to believe that men are stronger. The stronger sex. They would care for us females, the “weaker sex.”
But the reality was woman wanted freedom. They wanted out of the house. They were tired of that trapped feeling. Women wanted to be college educated, have good jobs and with good equal pay.
What women’s liberation missed was the need for good dependable childcare. If the mom and dad were both equally employed outside of the house, who was going to care for their children? And I mean good and affordable childcare.
Somehow we missed the mark on this. And our life became near impossible.

Now, not only did we have the good jobs, we still had to clean the house, cook the meals, care for our kids because our husbands or male significant others didn’t seem to have those “nurturing skills.” So we had to do it all!!

I bought the myth. The fairytale.

I grew up with constant negativity. Mother was negligent and dad became a non-functioning alcoholic.
I was aware by the age of five that I was fat and stupid and ugly. A frequent message from my parents.

And not having an ounce of self esteem, I met what I thought was my Prince Charming. And he threw breadcrumbs of love towards me. And I grabbed onto those crumbs tightly. Because I was starving for love and affection.

Eventually we married. I was in love. I was quite naive. And the marriage became a farce. Many infidelities from my husband.
The degradation of knowing that and not being able to fix that.
He was a great father to our three children.
But the sadness was knowing that he really didn’t love me.
The sadness was knowing we were stuck in this dilapidated 2 bedroom trailer on 5 isolated acres.
I felt trapped. He had no desire to move out, to have a better life for us and our children, to get a better job or a second job, to stop being unfaithful.
Instead, it was up to me. With therapy, I expressed my sadness and my fears. I got a second job and now I worked at two different hospitals, working 60 hours per week, and I carved our family out of poverty and depression and isolation.
And I finally had a deposit for a house.

After 30 plus years of marriage, my unfaithful husband died of liver, pancreatic, lungs and lymph node cancer.

As I reflect, as a woman, maybe we are the stronger sex.
I see many men as weak and unreliable.
And though I would love to have a trustworthy and loving relationship with a man, I can’t see their soul, so I stay away.
I’m certain there are good men out there.

I see the good men in my son and son-in-laws and I’m thankful for the love they give to my daughters and the love my son gives to his wife.

But I can’t go through the trauma again
of allowing someone to step on my heart.

And I realize, for me
The glass slipper doesn’t fit.
It never did.

Behavioral Health: Game over.

By: Debbie Moore-Black, RN

He was a tall healthy psychiatric technician. Experienced in this line of work. He was a CNA but he wanted more. He wanted to help heal the troubled. The forgotten. The neglected.
And behavioral health was his niche.

Every day he would lead the way with therapy sessions in this group. This was Intensive management. The intermittent home for the paranoid schizophrenics. Bipolar. MDD. They came in all shapes and sizes. Wealthy. Homeless, from prison. Neglected and abused from an earlier life. Parents with mental health issues passed on to them. Verbally and physically abused. Neglected of love and comfort and basic needs of living, of shelter, of a stable mom and dad.
Beaten physically and with constant verbal abuse.
And nowhere to turn.
No skills to fall back on. Distraught, lonely and vacant were their lives.
Jonathan was the best psychiatric technician. We could always trust him. We always felt safe when Jonathan was working.
He loved his patients. He always went the extra mile.
Until that fateful day.

Corey was a loner. Never graduated from high school. He was a drifter and easily went in and out of prisons.
He was born with cute chubby cheeks and dimples but birthed into poverty, neglect and violence. His 13 year old mother and his grandmother cared for him. But he only remembered physical and verbal abuse. He didn’t know his dad. In prison for murdering a friend from a drug deal gone wrong.
He remembers mom opening up dog food to feed him. The rats. He remembers well. And the best thing he could do was escape the filth, the decay and the lack of love from his hardened mother.
Schizophrenia was a common thread in this bloodline. With no medication compliance, no follow ups with free therapy sessions….

Corey had several felonies. Sexual assault. Robbing a bank, brutally mangling a stranger.

He was stuck in jail but he knew the rules to get a free pass out. Even if it was temporary!
In the jail cell he knew the tricks: like
put a sheet around his neck and threaten Suicide. Smear your feces on the wall. Stop eating or drinking…..
And he would be admitted.

We called our unit “Hotel Hilton”. Because it was luxury compared to the jail cells.
Three hot meals, refreshments, therapy sessions, basketball games in the gym, medications to calm you down, quiet your anxiety and anger and medication to let your restless soul sleep.

They came in frequently to our unit. Some wanted to be called the Virgin Mary. Or Jesus. Or cousins to Beyoncé or P. Diddy.
Some saw the FBI gazing at them through the cameras in the ceiling. Or the computer chip that miraculously planted into their brain by aliens.
We had them all.

Corey was hungry and at lunch he asked for “double portions”
Jonathan, the tech said he could only get him double portions from an MD order.
That could take time to get a physician approval.
Corey was angry and agitated. He wanted more food now.
Corey put Jonathan, into a headlock. And attempted to strangle Jonathan. Jonathan went limp and fainted.
Our male tech was dazed and confused, wheeled down stat to the Emergency Department . A CT scan was done to his brain.
Jonathan took a workman’s comp leave.
But he never seemed to be the same again.

I had been assaulted twice in this unit. A fist right to my jaw knocking me down to the floor. A beating to my head.
Several other nurses have been assaulted also.

I sent a email to our managers and CEO. Stating we had to be pro-active in this unit for safety. How we needed PSO’s (Public Safety Officers) in our unit 24/7. How they needed to make rounds every hour. How we needed some type of alarm device in our pockets should we be attacked.
And nothing has happened.
I received a verbal “reprimand” for adding the CEO to my email. I was told “He is not a part of our chain of command”
And nothing was done to ensure our safety.

Besides receiving my own therapy for PTSD for being physically attacked twice by these patients, my biggest fear was not being able to retire without some great injury coming my way.
A simple “snap” To my neck and then I’d know it was
“Game over”
I made it out alive but swore to myself “Never again”

Hospitals have those cute catchy names and phrases like “Excellence in care”, “dedication beyond measure”, “Enhancing Life”, “Incredible medicine, Incredible people”….. and the list goes on across our country.
Some of these catchy phrases are merely smoke screens…. Because the healthcare workers that are in the trenches…..
We know the truth.

Trinkets of Love:Upper management’s way of showing their appreciation to the Healthcare Professionals during Healthcare/Nurses week

By: Debbie Moore-Black, RN 🩺

Maybe we need to educate upper management, multi-million dollar hospitals with multi-million dollar per year salaried CEO’s and Board members with their financial perks that Health Care professionals and Nurses during “Healthcare/Nurse week” in May of each year…. That we are no longer in the second grade.

Maybe we need to remind “them” that we are college educated healthcare professionals, with degrees such as ADN’s, BSN, MSN’s, RN’s and LPN’s and educators and Nurse practitioners and Respiratory Therapists.

Last year, for our appreciation month, our unit on dayshift received pizza. The night shift received the 2 pieces leftover from dayshift.

Or the year before, when hospital wide staff all received a cookie. If you were a member of the “Resource team” and you went from one critical care unit to another, wherever you were needed, you did not get a cookie because you really weren’t a member of that “team.”

One year we all received lifesavers with a strip of paper that said “thank you for being a lifesaver”, or the institution that gave out real rocks with the statement “You rock” , and you may paint your rock with whatever will “empower” you.

This year, we received shoelaces. That’s correct. Shoelaces. With a sticky note that said: “We’re in this together, Every step of the way.”

Do we need to educate these high powered, upper echelons, that we are not 2 years old?

Do we need to go through a litany of how we save lives, how we bring patients back to life, how we do CPR, Code Blues, Code Cools, how we assist in open heart surgery, and CABG’s, dialysis, assist in intubations, manage ventilators and pressors and assist in inserting central lines and arterial lines, and titrations of life-saving IV medications, and ECMO’s and …

If your exhausted just reading this, imagine a 12-14 hour shift and no break, no 30 minutes, no 15 minutes.

Imagine the 24/7 cerebral perfusion we all do to save your loved ones life, or bring that baby into this world safely, or ease someone into a comfortable painless death.

Imagine giving us key rings, left-over pizzas, chapstick, lifesavers, rocks, shoestrings, a cookie.

Spare us these incredible insults. Disrespect. Disregard.

Of our healthcare professionals.

This year, I collected the shoestrings given to us and donated them to our local homeless shelter downtown.

We refuse to be disrespected anymore.

#Healthcare Week/Nurses Week.


Code Sepsis

By: Debbie Moore-Black, RN

It was a known fact. I was 4’11” but I had a mouth on me to compensate. I was loud and noisy. Fellow nurses called me the “Rebel without a cause.”
But I had a cause. I knew I was Samson against Goliath.
Most everything became my cause.
So I verbally fought my way through this iron-clad heavy management structure.
I had to fight for the betterment of the patients. For their survival.
I had to fight for the nurse that was being bullied.
I had to fight in front of an all management team that failed to uphold a safe 2:1 patient/nurse ratio.

I was invited to a grand Sepsis protocol debate.  The Sepsis protocol rolled out around 2003. This big meeting held Critical Care managers from ICU, Neuro-ICU, Coronary Care Unit and The Emergency department, Pharmacists, Respiratory Therapists, ER Physicians, and Intensivists and other important medical representatives across the country.
And I was invited to this “Think tank.”
I was the little fish in this big pond.

“Code Sepsis”
And at this round table with Heath care professionals who were use to pounding their chests on how good they set up this Sepsis protocol, I had to debunk it.

Sepsis was the new named diagnosis and if not treated rapidly and proficiently a patient could die.
Our numbers showed that our patients were dying.
Cardiac patients have the “golden hour”.
The sepsis patient had the golden hour also.
Sepsis: a raging infection that consumes most organs. Bacterial, viral or parasitic infections.
The symptoms: shortness of breath, dizziness, confusion, rapid heart rate, low blood pressure.

At our institution, a sepsis patient stayed in the ER for hours. Strategic life-saving protocols were stalled and when the patient eventually got to the ICU, precious hours had been missed.
We had to intubate these patients. Put in a stat central line and arterial line. Hang vasopressor drips, get stat labs and administer IV antibiotics. And add liters of IV Normal Saline.
The entire body had to be resuscitated.

I mentioned in the round table that we were doing it all wrong.
I recommended  a “Code Sepsis” should be announced overhead. The Rapid Response Team (RRT) should respond to the ER stat. A central line should be inserted stat and an arterial line. Stat labs. To include a lactic acid level, ABG’s, intubation, electrolyte profile, liver function tests, and kidney function tests.
All in all these procedures had to be preformed stat and simultaneously.
But they weren’t. They came to the ICU after being in the ER for several hours. Precious wasted hours. Precious minutes.

The round table got loud and argumentative.
But we began to settle on the truth. That we weren’t being aggressive enough, medically. And our patients were dying.
Protocols were rewritten and added too.
We fine tuned.
As an aftermath of this “think tank”, Code sepsis was now  called out overhead. The RRT showed up in the ER and with rapid succession of intubation and central line insertion, the patient was rushed to our ICU with the goal of one hour.

Feeling that I productively had added my 2 cents worth, 2 weeks later I was called to the manager’s office.
Our manager told me I was brilliant, my ideas were also “their ideas”.
BUT… she had to write me up.
Why?  Because I spoke “out of term”.
I intruded amongst these professionals. I was out of place.
In years to come, at this institution, I realized that they had to be the ones in control. They had to be the ones with the ideas.
I was just that brick in the wall and they wanted me to close my mouth.
I carried on relentlessly for the betterment of the patients and fellow nurses…. Until I could no longer feel any support.

They wanted me to be a yes person.
To serve, honor and obey.

Lesson learned: pick your battles!!

(Google stock photo)

The Fist

By Debbie Moore-Black, RN

I thought it would be easier than ICU nursing. After 33 years as an ICU nurse, I had to leave. I just couldn’t take the pounding on the chests of little old men and women. Hearing and feeling their ribs crack while CPR was performed. I just couldn’t handle these poor patients that should have had a peaceful death when the inevitable was near.
Family members with expectations of miracles. Denial. Rationalization.
And I had to take a break from my favorite dedication to ICU nursing.

Morally, I could not assist in keeping an end stage multi-organ failure patient alive artificially anymore.
So I chose Behavioral Health as my last “swan dance”. Thinking it would be an easier qpassageway to retirement.

But ICU nursing and Behavioral Health Nursing… they are apples and oranges. Both with incredible complexities.

He came to us from jail. He knew the tricks to get out of jail…. Temporarily. He smeared his feces on the walls in his jail cell. He started to talk about the FBI being a chip in his brain and suicidal ideations. And they knew they would have to admit him to our Hospital: Intensive Management Behavioral Health.
He had a long record: Domestic abuse/violence. Rape. Assaults with a deadly weapon.

Upon entrance to our unit, compared to his jail cell, we were nicknamed “The Hilton hotel”. Your own bedroom, with a bathroom and shower. 3 meals a day with interval snacks/refreshments. Medications to calm you down, to help you sleep, to help stop the voices in your head. To help you to relax. Loads of group therapy and gym time. Anything would be better than being in jail.

I always said my “anti-assault prayers” before entering this Behavioral Health unit. Sometimes they worked well for me, for us. But these patients were so random. Anything could be a trigger.

On this particular night, Sam started to act out. He was already very intimidating. He’d stare at the nurses. A fixed glare. He’d have verbal fights with fellow patients…. And then came the chair throwing, and tossing over tables in our community room.
We immediately called our Public Safety Officers (PSO’s) to assist the staff and to protect us and protect the other patients.
I readied my syringe, haldol, Ativan, Benadryl.
The trifecta.
We could not verbally redirect Sam to go quietly into his room.
So the PSO’s held onto him and guided him to his room.
He physically fought his way into his room, attempting to fight off the PSO’s while shouting out obscenities.
And then a calm came over his face.
I had to give him an injection.
He stood perfectly still. Rolled his sleeve up and said “ok, I’m ready”.
A PSO stood on each side of him.
Sam stood perfectly still and stoic.

For a brief moment, we chose to trust Sam. That he was willing to take this injection in his arm.
With my alcohol swab ready, I wiped his arm and then began to aim the needle.
Out of no where, the perfectly still and calm Sam, got his fist and aimed at my jaw.
I saw his fist coming toward me and I remember saying “Oh no”.
The strength in his fist made my entire body crash to the floor. My eyeglasses flew out in the hallway.
A PSO on each side of him, and we didn’t see him coming at me until it was too late.

Our biggest mistake was that we trusted him.

He then began to physically fight the PSO’s. And he was steadied, another nurse gave him the injection and the patient went off to the seclusion room.

I was immediately wheeled down to the Emergency Department. I was uncontrollably crying and shaking. I couldn’t talk. The physician thought the patient had fractured my jaw, I had contusions on the right side of my face. And I couldn’t move my mouth.
They wheeled me in for a stat CAT scan of my head.
Beyond the contusions, the Cat scan was negative. I was lucky.
I took 2 days off of PTO.
And I was back.

But things were different. I was fearful. Of any of these patients. I realized he could have done so much more damage physically.

But mentally, I was now damaged.
Dead bolting my doors at night at my house.
Waking up at 0300 seeing that fist come at me repeatedly. Dreams of unidentifiable men breaking into my home.

Obviously, I was experiencing PTSD.
And I have sought some long-term therapy.
I pressed charges against this man, but then that became a fear also. He could find me. He could look up my address.

My one comfort is knowing that my male
rat terrier dog protects me.
And though he is small, he would go at someone’s jugular for my protection.

It’s not an easy job.
Another real reason that within one more month I will retire from being a nurse.
If the lay people only knew the physical and mental abuse we take 24/7.