Perfect nurse. Perfect manager. Perfect puppet.

Originally published on KevinMD

Perfect nurse.

Perfect manager.

Perfect puppet.

An ICU physician once told me: Nurse managers have a life cycle of a mosquito.

Fast and furious.

And then gone.

Deleted until the next one shows up.

It was the perfect ICU.

Twenty-five beds.

Dynamic intensivists. Phenomenal.

And they respected us nurses and collaborated with us. We had perfect cerebral perfusion together.

Experienced ICU nurses who knew what to do like clockwork — teaching the younger new nurses. Teaching them the facts of ICU. The intricate signs of organ failures and how to have a second sense when things went wrong.

We taught them how to alert the doctors when a patient’s vital signs and lab work was showing signs of pending failure. We taught them to keep their cup half empty but to never fill their cup with overconfidence and arrogance. The nurse that “knows it all” becomes the most dangerous nurse.

We were a proud ICU. We earned our stripes.

We were the best.

Stephanie had three years of cardiac nursing under her belt. She glowed with knowledge, and she wanted everyone to know that she knew everything.

Her eyes were on the prize: management.

That’s all she ever wanted — to be the top dog. So she pushed her way to the top.

To the vintage nurses, she made us second guess ourselves. To the younger nurses, she increased their insecurities.

And to management … she was a dream.

She was their “yes girl,” and she played the part well.

No matter what she reported any situation that may have gone wrong to management, instead of confronting the nurse and the situation.

She was energetic and positive to management and anything they wanted or asked for she was right there to help.

She already had her BSN and was actively working on her MSN in administration/management.

Stephanie shadowed the manager while achieving her master’s degree.

She learned all of the “top secrets” of management and had them embedded in her brain. Her plan was to become the next manager. She was ready to implement all that she knew.

It wasn’t long after, that our manager of many years, Patty, had retired. And so with all of the bells and whistles, we sent her off with love and affection in our hearts.

She was our mama bear. She was the one that remembered our children’s birthdays, graduations and grandma’s funeral. She was the one that bonded us together and taught us how vital respect for one another was. She was the one that made this unit as our other family.

We worked hard, but we loved every minute.

Stephanie became the new manager, and we immediately saw a change.

During our daily huddle, she was frantic. We always did something wrong. Sometimes she appeared near hysteria. When the bullies joined our unit and degraded the older and new nurses, Stephanie closed her eyes to the truth. Mistrust and bickering and disrespect was a common everyday occurrence. And our ICU became like walking on eggshells.

We first saw the secretaries lose their jobs. The secretaries who watched non-stop 25 EKG monitors. They were given a two-week notice and were dismissed.

One by one, we saw the experienced nurses leave. And the unit was left with inexperienced nurses who were young and bright and jumped on being the new charge nurse and the new “rapid response nurse” (RRT. Code Blue nurse).

And they wore their name badges with pride. They were new and sparkly.

But they didn’t even know what they didn’t know.

And the awesome ICU that we once knew crumbled and lost its glow.

The air was thick and negative.

Our spirits were broken.

And we all moved on towards a more positive environment.

I miss that group of nurses and doctors.

We were family. It was as if we grew up together.

Memories. That’s what we have now.

We at least knew that no matter what, we were there for each other. We were there for the patient.

We could care less about how many degrees you had or didn’t have.

What we did care about was each other.

We knew we had each other.

Nursing’s newest problem: The young eating the old

Originally published on KevinMD

In 1976, we couldn’t wait to be nurses. Our starched white dresses with the nurse caps and stripes symbolized our graduation status as we were called one by one to receive our diploma and a rose.

We took an oath to care for the sick, to be professional, to critically think, to respect doctors and to respect patients and family members.

And to respect each other.

It was the age before computers. We learned how to calculate IV fluids in drops per hour and drops per minute. We had large folders that contained algorithms for sepsis, or myocardial infarctions or code blues. We had a three-fold flow sheet that we would manually document on. Threefold front and back. Blood pressures every 15 minutes and the pressors to coincide with the blood pressure. Everything was manually written from labs to a patient’s chart to MDs handwriting new orders — and endless charting of everything that happened to the patient in the ICU or CCU. We knew everything we charted had to be precise as it was always a potential for legal matters.

The handheld calculator had just come out on the market. It was the newest invention: $85 for a handheld calculator. So we were thrilled that we could now plug in some numbers to get an accurate drip rate for IVs or calculate dosages in an instant.

We were associate-degree and diploma nurses. And only the “elite” would earn a BSN.

We didn’t have breaks; they didn’t exist. We just kept working until it was time to go.

You worked the shifts your manager told you to. There was no compromising. You just did what you were told to do. We were the new pioneers in this field of nursing, and we were quite proud of ourselves.

Some older nurses did not communicate well with younger nurses.

Sometimes it was bullying the young. Or harassing or degrading a younger nurse who was just learning.

And the newly coined phrase appeared:

“The old eating their young.”

And the phrase stuck. Unfortunately.

And there was nowhere to turn. The managers turned their heads away. Sometimes the hazing was so bad that nurses would resign and even find a new career.

The nurses we couldn’t wait to be were riddled with harassment and ridicule.

And instead of holding each other up, we slowly destroyed each other.

Fast forward to the year 2000.

We older nurses are counting the years we can say goodbye to this long, hard, relentless career. This career that afforded our family vacations and a house and car and nice clothes and college for the kids.

This career that challenged us in the gut as we watched people live longer or die faster. As we said our goodbyes to our patients, we grew to love, and we’d gulp buckets of tears when it was over. Our last goodbyes to patients we loved.

We slowly evolved painstakingly learning the computer. And the computer was foreign to us. We were “special” and slow and didn’t adapt as well as the younger nurses did. These younger ones started computers in their home, in kindergarten and throughout the rest of their young lives.

Though they sported lots of energy, they walked faster than us, and they now had medical protocols and procedures right at their fingertips — instant knowledge.

But what the young ones didn’t know was that we were pioneers. We’re the ones with years and years of knowledge and experience and wisdom. And thus, the cycle of bullying was reinvented.

I’ve been a manager of an emergency department, I’ve been first assist to the surgeon, I’ve been a staff nurse and a charge nurse in ICU. And I’ve endured over 30 years in nursing. I have to continue working three more years before I can financially retire.

My sadness comes in when I hear the young men and women in this nursing career start the harassment.

“Where’s your hearing aid?”

“Are you STILL working?”

“Where’s your walker with the tennis balls?”

And then there’s a laugh.

But it’s not funny.

It’s sad and degrading.

It compromises our integrity, worth and our camaraderie.
 And instead of working together — we tear each other apart.

This is the hardest part of nursing.

I know it’s not everywhere, but it does exist.

And so now the coin has flipped.

The young eating the old.

Are we strong enough to stop this?

Are we strong enough to encourage positive work ethics and behaviors and to learn from the new and learn from the old?

Can this profession be saved?

It’s up to us.

All of us.





We came here for a reason. Let’s not destroy ourselves.