Create a positive light in nursing

By Debbie Moore-Black, RN

I was an assistant nurse manager (ANM) in a 24 bed ICU in my younger, energetic years. Before that, I was a manager in a very small emergency department. I must say, I loved it. I loved the thrill and the challenge. I was able to work with the Joint Commission; I ordered EKG monitors and defibrillators, any equipment needed for the emergency department. I worked with the health department and social workers. I helped develop protocols and talked to leading cardiologists in the city to create new protocols. I created an information pamphlet area for patients and visitors. I did evaluations and planned scheduling.

I went to the intensive care unit from the emergency department and found my true love. Before long, I graduated to the ANM. I was everyone’s friend. But I was also a rabble-rouser. Should an intensivist not follow a protocol properly, I reported him or her. Should our manager on call be missing in action for 24 hours, I reported her. I was an advocate for the underdog. An advocate for my nurses and nurse-patient ratios. An advocate for the patients.

I sounded the alarms no matter what. I didn’t “pick” my battles because almost everything was my battle.

I learned through the years what was worth fighting for. One of my managers was once deemed “an unassigned leader,” and “this could be good, but …”

Eventually, I was demoted to a staff nurse. I was told that I was not “one of them.”

So now I’m a little over a year until retirement. I don’t want to be a charge nurse; I don’t want to be a leader. I want to do my job as a staff nurse and then drift away into the horizon.

In my 35 years as an ICU nurse, I can sadly say that I have had only one good manager.

But what values did this manager have? She was fair and honest. We respected her greatly. One minute she’d help us with a code blue doing CPR, or passing out emergent medications during the code. Other days in her “spare” time, she helped us clean up a patient, bowel movements and all. If there was bullying in the unit, she squashed it. If a nurse was not up to par, she’d bring him/her into her office. She knew our names. Our children’s names. She’d ask about our sick grandma. She was smart and professional. And not only did we respect and cherish her, the Intensivists and hospitalists loved her also. Our ICU was a well-oiled machine. Sadly, this type of manager has happened only once in my 35-year career.

A new manager comes in with all of his/her titles and degrees. She has a bullwhip in one hand and a microscope in the other. She’s going to kick ass and take names. Every day we hear how terrible we are. How awful we are. That we don’t know our roles. That we perform below mediocrity. There is no light. Morale drops, job satisfaction is at an all-time low, and then comes the nurse turnover. Negativity does not promote a positive reaction. It festers and brews.

So how can a leader, a manager, turn herself around? How do you create a good workforce? Good camaraderie.

Professionalism and accountability? Good question.

We are a family. There’s no way out of it. We live and breathe each other for over 12 hours a day. Besides knowing your clinical skills and critical thinking skills, planning, and budgeting. Evaluate yourself. If you are in this managerial role for control, power, or self-gratification, you’re in it for the wrong reasons. Start with staff relations. Learn and know your staff. Keep communication open. Be honest. Answer your emails. Encourage positive behavior. Give kudos to those who go above and beyond or even those steadfast in good quality nursing and patient care. Encourage education. Ask about their children, their mom or dad.

When you beat us verbally with constant negative ridicule, we crawl under the bed. We underperform. And eventually, we disappear. Delegate, be honest. Open communication. Have goals. Positivity. Correct poor work in privacy. Make nurses want to work for you and with you.

After earning your master’s degrees and PhDs, please take off your mask and remember we’re all human. We’re all in this together. And create a positive light through the tunnel of a very difficult profession called nursing.

Originally published at Kevin MD

COVID doesn’t matter to them. Until it matters.

By Debbie Moore-Black, RN

As I take the pups on their daily walk around the neighborhood. I come upon eight adults outside their houses, near the street, laughing and coughing and sneezing and smoking their cigarettes and huddled up close together.

They didn’t say hello to me, nor did I to them.

But I listened: “I ain’t gettin’ the COVID vaccine, I ain’t going to the hospital. If I get the COVID, I’m staying at home and taking NyQuil, and Robitussin and Ambien … and whatever I can lay my hands on.”

I don’t go out much. Except for my walks, to the grocery store or to work. The local grocery store states mandatory masks, but there are always those that don’t care. As I stood in line recently at the grocery store, distanced myself at the cash register, mask in place, a man comes directly up to my face and coughs on me. And then he begins to laugh.

I don’t know what happened to genuine respect for each other. Common courtesy during this pandemic. Apparently, some people have been convinced that Covid is not real. Or not a big deal. And laughing in the face of science, medicine, and facts.

I guess they don’t know we’re running out of ICU beds and ICU nurses.

And I guess they don’t know we are running out of propofol and dexamethasone. Propofol for intubation and sedation and dexamethasone for the lungs’ inflammation due to the COVID virus attacking the lungs before it makes its way to all other vital organs.

I guess they don’t know about masks or social distancing or the COVID vaccine.

We are running out of basic tube feedings for patients. Running out of plasma. Some city hospitals are full. Our hospital has turned our ICU rooms into two Covid patients to one room. One room that use to be for one patient. Gift shops and conference rooms are converted into COVID beds. Hospital tents are being installed in certain cities.

We are running out of body bags.

The critical care nurses gown and glove and masks and face shields for 12 hours straight. There is no 30-minute break. It is lifesaving ICU room to ICU room. Lifesaving. Or surrendering to another death.

I guess they don’t know that our America now. Today has 356,000 dead people due to COVID.

I guess it doesn’t matter to them until it matters.

Originally published at

Schizophrenia: They are on an island of their own

By: Debbie Moore-Black, RN

I knocked on his door. It was 8:30 pm. Medication time. Jerome slowly opened his door. He was easily over 6 feet tall.

Towering over my 4ft 11,5 “ self. Naked. Eye to eye with his penis.

He chanted “you ain’t a bitch. You ain’t a ho….. you my wife”

Ok Jerome, take your medicine.
I’ve entered a new dimension of nursing.

After 30 plus years as an ICU nurse, I thought I’d ride out Behavioral Health until my retirement in one year. I thought it would be easy.

What I didn’t realize was that we have a most complicated mind. All of us.

I smiled during my interview. Told them what they wanted to hear. And I was in.
Day after day. This was the psychotic unit. Psychotic, schizophrenic, bipolar…. all of the above. Medication was sometimes our only hope.

It’s cold outside. Winter time. The homeless know what to say. On the streets, our hospital, our behavioral health unit is like the “Hilton”.

New scrubs, private rooms, breakfast lunch dinner and snacks. A shower. And medications to calm you down, to help you sleep to make those voices in your head disappear for a moment.

The voices that say kill… kill… kill. The voices that tell you you’re no good. Cut yourself deeper faster. Jump off the bridge, run into traffic…. anything to make the voices go away.

Marlene is 52. She likes methamphetamine. She has multiple husbands and she’s pregnant with the baby Jesus. And screams a bloody chilling scream in the middle of the night.

We rush to her side. She bangs her head repeatedly against the wall. It’s hard to deescalate a psychotic. Medication is your only friend. Haldol, zyprexa, Ativan, Thorazine. Take your pick.

Our heroes are Public Safety. We push a button, or call the number stat, and they are there. All of them 4 and 5 of them rush to our side to protect us.

This is not a prison. This is a Behavioral health unit. And each day we say a prayer that there won’t be violence. That there won’t be an assault. That we won’t have to put someone in seclusion. That we aren’t forced to use 4-point restraints.

These are the misfits. The homeless. The non-compliants They know when it’s cold outside. They can no longer cope. We are their friend. Their protector.

Schizophrenia. A strange and exotic disease. They are on an island of their own.
What have I gotten myself into?

Originally published at

During the pandemic, many health care workers won’t be home for Christmas

By Debbie Moore-Black, RN

He was a healthy 36-year-old paramedic with a loving wife and an adorable little boy.

Jim loved his job. The rush, the adrenaline, the blaring lights through downtown hurrying to get to the major hospital. Cardiac arrests, gunshot wounds, tragic auto accidents, respiratory arrests, CPR, compressions, starting IVs. Speaking to the ER physician en route to the hospital to give stat meds for V-tach, SVT, delivering a baby. Anything and everything. Jim was there and ready for the next life-saving event.

COVID was rapidly spreading throughout the country. Standards and compliance with wearing masks were not always a priority. PPEs were also not readily available to health care workers. Jim was aware of the risks involved. But he was young and healthy. And in a hurry.

It couldn’t happen to him.

Jim developed a cough. A dry, persistent cough. And then he lost his sense of taste and smell. His energetic self became weak and lethargic. His temperature rose to 101.6. His manager said he must be tested for COVID. His test was done and processed urgently.

Jim tested positive.

Jim had to be quarantined from work from his squad. At home, Jim stayed in a separate room. Away from his little son and wife.

Within one week of testing positive, Jim continued with his cough, but he became short of breath. His wife found him gasping for air in his bed, and she immediately called 911. His fellow paramedic partners picked him up. Put him on a stretcher, added oxygen, started an IV. His O2 sats were 82 percent. Jim was pale, gasping, and barely able to talk. He was rushed across town to the ER.

His O2 sats continued to drop. His wife held his hand. We love you. She said.

Jim was brave. And he replied: I’ll be home for Christmas. As he squeezed his wife’s hand.

Stat ABGs showed the need for emergent intubation. O2 sats now 76 percent.

Jim was intubated, a central line inserted. Nimbex (a paralytic) started along with a propofol drip. He was transferred to the ICU. IV steroids started along with his first dose of remdesivir. His blood pressure dropped dangerously. Levophed drip was started.

November slid into December.

Week after week went by. Jim’s kidneys shut down, and now dialysis was started. The ICU nurses and physicians worked endlessly. There were no breaks—12 to 13-hour shifts. Jim’s nurses enter his room. Day after day. Shift after shift. Isolation Gown, gloves, N95, face shields, shoe covers. Grueling and hot and suffocating.

His wife, Mary, calls up. Needing a report of her husband. Her voice quivers. The nurse allows FaceTime with Jim’s wife and four-year-old Timmy. We love you. She says. And all she sees is Jim on the ventilator with a distant stare of no comprehension. She leaves pictures Timmy drew for his dad at the hospital’s front entrance. Jim’s ICU room walls are covered with pictures of Christmas trees and Timmy’s handprints and hurry home, daddy.

The intensivist calls for a conference with Jim’s wife. We’re sorry. We are not making headway. He’s deteriorating. COVID has destroyed his kidneys, his lungs. MRI shows minimal brain activity. Despite everything we have done.

His wife bows her head. A tear stings her cheek as she remembered his grasp of her hand: I’ll be home for Christmas.

Internationally, 7,000 health care workers have died from COVID. Physicians, nurses, EMTs, paramedics, housekeepers, technicians, plant engineers have perished as they heroically face this silent killer.

Originally published at: Kevin MD

Don’t Wake Me Up Again

By: Debbie Moore-Black, RN

After 33 years as an ICU RN, I had finally decided I couldn’t do this anymore.

It was my last nightshift. The last shift that convinced me I had made the right decision.

The CNA and I went door to door to turn each ICU patient that was not capable of turning themselves.


Mrs. Thelma was 86 years old.

She laid in her bed slightly restless. Restrained. On a ventilator. NG tube for tube feedings. Levophed drip for a low blood pressure.

Mrs. Thelma was not able to turn herself.

The CNA and I knocked on the patient’s door. Her son was asleep on the side bed provided for families.

Her son woke up. “What do you want”? Why you waking me up”?

We explained that we had to turn his mother.

His poor gray haired mother. Attempting to extubate herself. Attempting to pull out her NG tube. Too weak to turn herself. Restrained to prevent her from extubating herself and pulling her NG tube out.

The family wanted everything done.

We turned and repositioned Mrs Thelma. We cleaned up the bowel movement in the bed and changed her sheets. I gave her a small amount of morphine ivp for comfort.

I held her hand and silently apologized to her.

I was sorry her family was not rational.

I was sorry her family thought she’d live forever

I was sorry that they were the reason she suffered so.

There was a family conference. The ICU MD explained she was going through multi system organ failure. She’s 86 years old.

That they could allow her to die peacefully.

But they wanted everything done.

And so we did. Painful day after painful day.

Every 2 hours we had to turn and reposition her or decubitus ulcers would set in. Suction her mouth and ETT, rub her back. Clean her body.

Her eyes were hazy. A living hell.

We left the room after we tucked her in.

The son announced: “don’t wake me up again”

I prayed for a peaceful death for Mrs Thelma…. but not this way.

My last night, clocking out to people who refuse to allow their loved ones to die peacefully.

I tried. I educated.

Many refused.

I could no longer deal with the torment that lies in the ICU.

To family members: We do the best we can.

We are not your servants. We are not your waitress/waiter.

We are caregivers. Professionally educated to treat your sick loved ones.

Please work with us.

We are strong…. but we are tired.

Respect and Empower.

The Prison: Covid ICU

By Debbie Moore-Black, RN

By: Debbie Moore-Black, RN

I enter the hospital to work again. I must work as I have 3 small children and a husband presently out of work d/t Covid. He is “non-essential.”
There’s a violinist playing at the employee entrance. I know they do this to lift our spirits. But it’s a slow sad string that reminds me of the titanic. And yes every day I clock in, I feel as if it’s a sinking ship.

By now we should have plenty of N-95’s, plenty of face shields and gloves and disposable gowns to enter that covid room, that Covid patient that never goes away. That continues to multiply.
It’s a painful job. I thought I would be saving lives as a nurse, but instead we are prolonging death.
This ICU is 24 beds. All Covid patients. 24 strong. I gown and glove and put my N95 mask on and face shield to enter that patient’s room. That patient with Covid… he’s 40 something, and he refused to wear a mask anywhere. Said it was a hoax. Said it wouldn’t happen to him. Spread his infection to his mom and grandmother and anyone else that potentially came in contact.
He had come gasping for air to the ED. It didn’t help that he was an everyday 2 pack of cigarettes smoker. That everyday he downed several cheeseburgers with fries and a milkshake. That every night he drank many cans of beer.
He said it was against his rights of freedom to wear a mask. He said it was a muzzle. He said he wasn’t going to be one of those sheep that follow a ridiculous rule of social distancing, washing hands and wearing a mask.

The muzzle he said suppressed his right to speak.
And now he contacted Covid. His O2 sats were in the low 80’s, he had co-morbidities like being over weight, high cholesterol, cigarette smoker and now his lungs were failing him. As Covid easily attached and infected his lungs.
It was only a matter of time for Johnny to earn dialysis, multi-system organ failure crept in. Kidneys failing, blood clots to his brain. And no matter what we did with those miraculous drugs of remdesivir and steroids, it wasn’t working. His breathing became asynchronous with the ventilator. We called it “guppy” breathing. Like a fish without water. He couldn’t follow commands. Family held tight for hope. For a miracle.
The MRI showed no activity to his brain. Anoxic injury with blood clots.
Covid rapidly ate through his body.
I pulled my work phone out, heavily encased in a protective plastic, so I could face time his family.
No holding hands. No final kiss on the cheek.
Just a final vision of Johnny.
We pronounced him dead at 0515. Notified the family. The morgue was notified. Make room for one more dead person to be stacked on top of another like multiple bunk beds.

Gave him his final bath. Toe tied him for his identity. Wrapped him up in his morgue plastic zip up bag. And we sent him off.

Clocking out we all face local police and administrators and firemen and medics cheering us on. Congratulating us. Calling us heroes.
Free pizza and ice cream for us.
And we bow our heads low.
Because we don’t want the cheering and balloons and the violinist and the pizza and ice cream and clapping hands.
We don’t want to be called heroes.

What we want is respect for each other.
What we want is for you to wear a simple mask.
What we want is for you to social distance and wash your hands.
What we want is for you to allow us to clock out and go home to our families safely without feeling that we potentially could infect our loved ones because of you being so incredibly careless.
Pay attention to science and medicine or else you may be the next careless victim.
Wear your mask.
Deal with the truth and get over your ego.

All Intensivists Are Not Created Equal

All Intensivists are not created equal.

By: Debbie Moore-Black, RN

I’d like to preface this story with saying that the majority of the Intensivists I have worked with have been exceptional, caring, and professional. We had all established a good camaraderie and we had mutual respect for each other. We worked well together.

But there always seemed to be one that was the exception.

And as I drive some long miles on a recent “get away” to the mountains…, the flashback came back to me.

Joellen was 64 years old. She smoked all her life. 2 packs of cigarettes a day. She started smoking at the age of 16. Hollywood made smoking sexy and romantic.

By the time she was in her late 50’s she developed severe shortness of breath without exertion. She had difficulty breathing. She wouldn’t put her cigarettes down.

Her physician told her: “If you don’t stop smoking for good, you’re going to die.”

In and out of the hospital she progressed to a diagnosis of CHF and COPD. Her physician told her at the age of 64 she was now considered “end stage” COPD. There was no regimen of care for her as her lungs were destroyed by her incessant smoking.

She agreed to sign a Do Not Resuscitate as she entered the ICU one last time. She did not want to be intubated. But she agreed to be medically treated.

It was now my shift. Night shift. And Joellen had a very bad day. Her breathing was shallow, her lips were cyanotic, her O2 sats were in the 80’s.

It would have been an optimum time to place her on “Comfort Care”, but the patient said she wasn’t ready to die.

Throughout the night, I watched Joellen breathe with great painful effort. She sat straight up in bed, shallow forceful breathing.

She suffered so.

I notified the “Virtual MD” to request morphine for Joellen. She had nothing ordered to ease her breathing. Even a small amount Morphine IVP could help relax and slow her breathing down without as much struggle.

The virtual MD said “no” he would not order morphine for her. I explained how she was awake and alert and suffering terribly… but he said “no, I don’t want her to get addicted to the morphine.”

I then Notified the Intensivists on call.

That was our chain of command.

Before I could explain myself to the Intensivist on call, he said to me “Do you realize you woke me up from my bed at 0300”?

I told this physician how Joellen was having shallow breathing, diaphragmatic breathing, low O2 sats and she was suffering greatly and all I wanted was some Morphine to give to this poor lady to ease her breathing and her suffering.

He let me know he would get back to me after he talked to the Virtual MD.

One hour later, I received a call back from the MD on call. Lasix 20 mg IVP stat. That will take some fluid off of her and it will help her breathing.

We don’t want her to become addicted to morphine”

And that was his answer.

And here I was faced with a dying woman. Lasix didn’t touch her. Her breathing became more shallow. Her lungs filling with fluid, barely able to auscultate. Her O2 sats slowly dropping to the 70’s and 60’s.

I sat next to Joellen and held her hand. Wanting to breathe for her. Wanting to comfort her…wanting to provide her with just a small amount of morphine…. but unable to.

I was given the most inappropriate order ever from 2 MD’s who claimed a dying woman would potentially become addicted to morphine.

Poor Joellen. As I held her hand, her breathing slowed to a minimum. She had worked so hard. Her eyes rolled back, and she let out her last breath.

I felt defeated. That a simple order from an MD could not be obtained.

Joellen died a painful death.

Eventually I found out that there was a review of this “case”.

I’m sure there was a “mild reprimand”

I drive up to the mountains. The leaves changing into their vibrant colors…

And I still see those haunting eyes of Joellen.

A CEO with the keys to the kingdom. And the pharmacy.

By: Debbie Moore-Black, RN

1986. I graduated from LPN to RN. And I was immediately offered a new job. Manager of a six-bed ER.

This hospital had three surgical suites — 50 inpatient beds and 2 L&D suites. This was a private Catholic hospital run by the nuns. The computer system was new and a foreign object.

Sister Ursula* (name changed) of medical records was so overwhelmed by the volume of paper charts that she hid many charts underneath her bed in the nearby convent. The nuns ran around during dayshift praying for all the patients and sprinkling “holy water” on those that requested it … or didn’t request it. There were crucifixes everywhere.

Our truly beloved CEO had just retired. He was a good, honest family man that knew everyone by their first names. We actually liked him!

But he quickly retired and moved himself and his wife to the mountains.

We were a small hospital out in “nowhere land” where you’d find farms loaded with cows, goats and chickens. Miles and miles away from any “real hospital.”

But we had it all in that ED!

Young women coming in with abdominal pain, only to find they were ready to deliver a non-prenatal care baby. The one ED doctor at hand did the delivery … while I caught the placenta.

We took care of gunshot wounds, stab wounds and cardiac and respiratory arrests, child abuse and rape cases, “done fallouts” during church services, diarrhea and constipation and runny noses and coughs from little kids.

We truly got it all.

We were a smorgasbord of every possible diagnosis. One nurse, one doctor and one secretary in that ED.

I thought I was hot stuff.

The CEO that retired gave me carte blanche to order EKG monitors and defibrillators, surgical equipment, crash carts. Beyond taking courses on “how to be a manager.”

I also took those CEUs on emergency nursing, staffing, public relations, and public education.

I was young and on fire.

I loved the code blues, emergent deliveries, chest tube insertions, intubation, calling medics to transfer a patient to a larger hospital, writing protocols, dealing with JCAHO. The list was endless.

And then we were notified by human resources that we had a new CEO.

He was 35-ish. Seemed like a baby. But apparently, he had experience and came from a much larger hospital.

He had shiny shoes and a perfectly starched shirt. I was always on guard and suspicious of shiny shoes.

He was our new CEO.

Immediately, I could feel the difference in this small-town hospital. The family atmosphere was disappearing. The staff was on guard and on edge. At any given time, especially at night, the CEO would come to visit us to make sure everything was OK.

It seemed odd, and he’d drop in at random hours in the middle of the night.

Our pharmacy was closed at night. Only the nursing supervisor had a key for meds that were needed stat throughout the hospital. Meds that hadn’t already been stocked.

But he had a key to the pharmacy.

He would tell us that he had to make sure the pharmacy was locked and that there was no suspicious activity. No one said anything out loud, but if you could just hear our thoughts.

Month after month and the same routine.

Rumor had it that the CEO started to fall asleep during executive meetings, board meetings. He’d visit us nightly in the ED. Slurred speech. Incomplete sentences.

We knew something was wrong.

We also knew if we said or mentioned anything, we could get into big trouble.

Every day the pharmacist clocked in. The pharmacy techs would assist the pharmacists in filling carts, restocking code carts, checking on the narcotics. The pharmacist knew something was missing. The Percocets, the Ativans, and Xanax, the morphine injectables. There was a dent in the narcotics. The narcotic inventory was reduced but without rhyme or reason.

The pharmacist called the pharmacy company (separate from the hospital), and cameras were installed.

And there he was some nights with a paper bag in his hand. Taking whatever he needed.

He was caught on camera. Immediately whisked away to some rehab facility.

And we never heard from him again.

He was a tormented soul thinking he could get away with stealing and using narcotics because his cover was being the CEO.

I can’t sleep tonight

By: Debbie Moore-Black, RN

I never have a problem going to sleep. In fact, after I work night shift, I easily go into a “semi-coma”.
But tonight is different. 2 days off from work, with a regular sleep schedule at night, but my mind is twirling.

I can’t sleep.

So at 0300, I took a shower. Took an ibuprofen with some ginger ale….. and I started to drift….. back to Catholic elementary school. We were 7th graders. I was in a group that did a “hip” musical mass with us kids playing drums, guitars and cymbals and tambourines.

We were cool.
I wanted to play the Beatles song “Let it be”.
“Mother Mary comes to me, speaking words of wisdom, Let it be”
I thought the song was about the Mother Mary, you know, Jesus’ mother. It was actually about Paul McCartney’s mother, Mary. A tribute to her.
But the kids voted me down. They said the song was sacrilegious. And I never got to play it at the guitar mass.

Fast forward…. when my kids were little, we joined a Presbyterian Church. I taught 3rd and 4th graders bible school on Wednesday nights. I loved it. We had decided to put a concert on with music and skits for our congregation and for the public. All donations would go to a local Soup kitchen.

Since I was the director/producer of this awesome show, I got to pick and choose. Of course the children had a say so of what they wanted too.
So with cymbals and guitars and drums and tambourines in hand, we put on the grandest show. “This little light of mine”, “Kumbaya, my Lord”, “I can only imagine”, and other social awareness skits were played out.
And now it was my turn.
I propped myself on the stool. My cherished guitar in hand, and strummed out the song I was forbidden to play 30 years ago.
Let it be.
Tonight, my memories of such an awesome, meaningful event came back to me.

We are living in a harsh, sad and tragic world filled with turmoil. But the words are profound and comforting.
“When I find myself in times of trouble, Mother Mary comes to me, speaking words of wisdom, Let it be, let it be”.
And when the broken hearted people living in the world agree, there will be an answer, Let it be. 🎶

We collected over $200 that night and handed it over to the minister in charge of the soup kitchen.
That was a special night. I hope I taught my 3rd and 4th graders something special. Like caring for one another. Love one another. Respect each other.

We sure could use this today. And always.
So I’m going to attempt to go to sleep again, and hope for a better tomorrow. A kinder tomorrow.
There will be an answer.
Let it be.

(The Beatles: Let it be)