Life of a Nurse: An Insider’s View of What Really Happens in a Hospital, Through the Eyes of an Rn

By Alice Marlett

A complex healthcare system involving many moving parts often makes us forget what matters most is the people. Marlett presents her observations of the inner workings of the hospital system with a book that tells what it is really like to work in one as a nurse.

Not only does Marlett tell us her story, but she also tells us her patients’ stories. And it’s their stories that ultimately form the heart and soul of Marlett’s book.
— Dylan Ward, The US Review of Books

If I was considering a career change, this book might encourage me to become a nurse, or it might dissuade me from becoming a nurse. Either way, it’s a no-holds-barred look at nursing. Alice Marlett’s writing is so descriptive that readers will feel like they’re on the hospital floor with her.
— Joe Wisinski, Readers’ Favorite

I liked…the uncompromising honesty concerning cases of negligence in health facilities. Further, the book sufficiently explores the risks associated with understaffing in nursing.
— Kibetious, Online Book Club

• Language: English
• Publisher: Archway Publishing
• Release date: Mar 15, 2021
• ISBN: 9781665701549

Alice Marlett

Alice Marlett has a Bachelor of Science in Nursing degree and is a Registered Nurse.

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Copyright © 2021 Alice Marlett.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the author except in the case of brief quotations embodied in critical articles and reviews.

This book is a work of non-fiction. Unless otherwise noted, the author and the publisher make no explicit guarantees as to the accuracy of the information contained in this book and in some cases, names of people and places have been altered to protect their privacy.

Archway Publishing

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Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

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ISBN: 978-1-6657-0153-2 (sc)

ISBN: 978-1-6657-0154-9 (e)

Library of Congress Control Number: 2021900602

Archway Publishing rev. date: 8/19/2021

CONTENTS

Introduction

Chapter 1: Skilled Nursing Unit

Chapter 2: Oncology

Chapter 3: Psychiatric Hospital

Chapter 4: Long Term Acute Care

About The Author

INTRODUCTION

I had never considered becoming a nurse until, at the age of 36, I was going through a divorce, and had 2 children. I was not earning enough at my job as a furniture salesperson, so I thought about my options, and decided that I should get a college degree. I heard there was a nursing shortage, and the pay was good. I applied for federal loans and grants. I was eligible for them, and I was accepted at a university with a good nursing program.

The first semester of nursing school was the hardest one. I heard it’s that way so students who are not going to make it through the program will drop out early. Somehow, I made it through, and graduated with a BSN in May 1999.

After graduating, I married Allen, a man I had been dating all through nursing school. He was divorced and had 4 children. The oldest girl, Tina, had graduated from college and was already married. His daughter Sarah was away at college. His oldest boy, Brent, was going to junior college, and his youngest, Rick, was in high school. My daughter, Susie, was in junior high. My son, Alex, was in high school, and lived with his father.

After my divorce, before Allen and I got married, my ex-husband took me back to court to try to get custody of Alex and Susie. He was living with his girlfriend; he thought she could take care of the kids, and he would not have to pay child support.

Alex had been hanging around with older boys. They smoked pot and were not a good influence. He was getting harder to control, and I thought it might be good to have him live with his father and get away from our neighborhood. We agreed that Susie would stay with me.

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ONE

SKILLED

NURSING UNIT

My first nursing position was on a skilled nursing unit known as SNU. It was a sub-acute care unit. This kind of unit is for patients who are not sick enough to stay on an acute-care floor, but too sick to send home. The unit had nursing and physical therapy staff. There were 9 rooms with 18 beds. The day shift had 3 nurses and 2 nurses’ aides, known as PCAs. (patient care assistants). The Physical Therapy staff was there from 9 to 5, Monday through Friday. The second shift on Monday through Friday consisted of 2 RNs and 2 PCAs. The third shift had 2 RNs and 1 PCA. I trained on the day shift for 2 weeks, and then started on the second shift working 3 PM to 11:30 PM, Monday through Friday.

My second week on the job, while still in training, I experienced my first patient death. It was Monday morning, and I was starting to pass out the AM medications. I did not know all my patients yet, because some had been admitted over the weekend. I was told in shift report (patient information given from one shift to the next), that the patient in my first room did not swallow well, so I crushed his medication and mixed it with applesauce. The patient was sitting in a chair outside his room, in the hall. He was a large man, about 250 pounds, with pale skin and gray hair.

When I walked up to him with his medication, he said What’s wrong? Something is wrong! I thought he was confused because the patients in SNU often have dementia. I said Try to take your medicine, and you will feel better. I gave him about half a teaspoon at a time, with small sips of water. He barely finished it when he slumped over in his chair. Another nurse was watching, and she ran to us. She yelled for Rose, our unit manager. A code blue was called.

Within minutes, the room was full of staff and a doctor. They were unable to revive him. Rose talked to me later that day and said what happened was for the best. The patient was scheduled to go to a nursing home that afternoon. He did not want to go, but his wife could not take care of him at home. Rose said the man’s wife had told her that she prayed he would die before he had to go to the nursing home. He was suffering, and being sent to the nursing home because there was no other choice. He would have been miserable there.

That was my only patient death while I was in training. I was not an RN when I started at the hospital, but a GN. (graduated nurse) That meant I had a few months to pass the State Board of Nursing test. I had to pass it the first time I took it, or I would lose my GN status. Then I would not be able to work as a nurse until I passed it and got my RN license.

I studied as often as I could, and even brought flash cards, with possible test questions, with me to work. I was nervous about taking the test, as most nurses are, but I passed and got my license. Soon after that, I started on the second shift. I also took a part-time job working weekends at a rehab hospital. Two of the day shift nurses worked there part-time and told me about it.

The nurse working with me was Mae. She was an experienced nurse from Canada, about 60 years old. She had been working at this hospital for over 10 years. She was always finished with her work on time, even though she was never in a hurry. No matter how hectic things seemed, she was always calm.

Our 2 PCAs were Cindy and Bonnie. They were both in their late 40s, and what I would call professional caregivers. They had worked together at the hospital for years and were best friends. They each had private care patients they would visit during the day before their shift started. They took good care of the patients and did not need to be told what to do.

The unit was busy with only the 4 of us for staff. The patients needed a lot of care. Most of them needed help to the bathroom. Some could not get out of bed, wore diapers, and had to be cleaned frequently.

Some of the patients who were admitted to the unit really should not have been there. They were patients who were dying but had used up all the days that insurance or Medicare would pay for on an acute care unit. The hospital was paid less for sub-acute care, but if no other facility would take them, the hospital was stuck giving care until the patient died.

I was fortunate to have an experienced nurse working with me. It seemed like I learned something new every day. I also learned a lot about patient care from Cindy and Bonnie.

I was working in SNU on a Thursday evening when Allen called at about 9:30 PM and said that he had just came in from mowing the yard. He was heating up some left-over beef stew and called to see how I was doing. He said everything was fine at home.

About 15 minutes later he called back and said that Brent, his oldest son, was having an asthma attack. Brent’s fiance, Maria, had called Allen. They lived in an apartment about an hour drive from us. The hospital where I worked was about half-way between our house and their apartment.

Brent had asthma all his life, but it was under control, and he seemed to be growing out of it. He was not taking any asthma medications, except for an albuterol inhaler when he needed it. He was physically fit and a handsome young man. He was going to college to become a respiratory therapist. Brent was 24 years old, and the kind of son that anyone would hope to have.

Maria told Allen that she had come home from work and was getting ready to go to a movie with Brent. He had a cold and had just heated some lentil soup when he started to have trouble breathing. He told her that he thought she would have to drive him to the hospital.

Brent was standing in front of a fan, trying to breathe, and then fell over and was unconscious. Maria called 911, and then called Allen. She told Allen that Brent was not breathing. Allen asked if he had a pulse, and she said I think so. She did not know how to do CPR.

Allen thought that Brent would be admitted to the hospital, like he had been several times before, and then would be alright. I had a sick feeling in my stomach after Allen told me that Maria said Brent was not breathing.

I told Allen I would try to get off work early, and he said he would pick me up so we could go to the emergency room together. Mae said she would cover my patients for the rest of the shift. I was trying hard not to cry, and Bonnie asked me if there was anything she could do. I asked her to get directions to the hospital that we were driving to.

The drive from my hospital was only about 30 minutes, but it seemed like hours. When we got there Maria was alone in a small, private waiting room. I knew that it was bad when I saw her crying, and no one would tell us anything, except the doctor would talk to us. The doctor came in and told us they had been unable to resuscitate Brent.

I went over to Maria and tried to comfort her. I think she already suspected the worst. Allen was in shock. I went over to him and held him. He couldn’t speak. He was just shaking. After a few minutes I went up to the nurses’ desk because I knew that someone would have to sign the hospital forms. I didn’t think Allen was up to it, and I had Brent covered as a dependent on my health insurance. They asked me about an autopsy, because the normal procedure in a case of sudden death was to have one done. I told them that Brent had asthma all his life, and I was sure he had died of an asthma attack. I told them he was studying to be a respiratory therapist and was a good kid. I said that I didn’t think the family would want an autopsy. A call was made to the coroner, and he agreed it was not necessary.

I asked where Brent was, and if I could see him. I still had my nursing uniform on, so the staff probably thought I would be able to handle the situation.

Brent was in a private room. He looked like he was sleeping. I touched his face, and it was still warm. The nurse asked if I wanted to take his things. There was only his clothes and shoes. They were dirty from what he had been through. I took his wallet out of his jeans and told them they could throw the rest away. I took the wallet to the desk so they could copy Brent’s ID and insurance card. Then I went back to the waiting room where Allen and Maria were, and gave him the wallet.

A chaplain was called, and Brent’s mother came with her husband. We were taken to a chapel, and everyone prayed and cried. A funeral

home was called, and we agreed to meet there the next day to make arrangements.

I went back to work the day after the funeral, but the grief Allen and I felt was just too much, so I took a week vacation time. As sad as I was, I could not imagine how sad Allen must have been. It felt like a heavy, dark cloud was all around us.

I realized how precious the time spent with our children is, and I decided that I should spend more time with Susie. I tried to get a day shift, or a weekend option position at the hospital, but nothing was available.

September 5, 2000

I applied at the hospital I had worked at part time as a nurse’s aide while I was in nursing school. It’s close to home, and they offered me a position working on the day shift. I can work three 12 hour shifts each week, and I will be charge nurse on the skilled nursing unit. I accepted it. I quit my full-time position, but stayed on staff there part-time, and will only work once every week or two, if they need me.

September 26, 2000

I have started working at my new job. The hospital is old and small, compared to most hospitals. I really like working there. I have fewer patients, and I can give each patient more attention. The other charge nurse on our unit, who works on the days I am off, has been there about 15 years. She insists the unit is kept spotless, and the patients get the best quality of nursing care. Most of the patients on our unit are older and have had recent surgery. Many of them need IV antibiotics and are too weak to get out of bed.

October 31, 2000

Today when I went in to work my regular day shift, I was told that the hospital is closing. It had been announced the day before, when I was off. The hospital is in bankruptcy. Patients will have to be transferred to other hospitals in the area.

Our health insurance was canceled, effective yesterday. I didn’t have much holiday or sick pay built up yet, but many employees had worked there for years, and had been saving their vacation days to cash in when they retired. All their vacation and sick pay was gone. There was no severance pay. The hospital only offered a bonus of $75 per day to employees who would help clean out everything that needed to be shredded, because it had personal information on it, and put things away that needed to be stored, or throw away unneeded items. This was expected to take about 4 days, and then the hospital would be locked.

There are 2 patients that I will never forget. One was a large black woman in her 60s. The first time I went in her room, I was shocked by the smell. It was the strongest and most revolting smell imaginable. It was worse than skunk. I tried to hold my breath while I got her tube-feeding ready. Her eyes were open wide, like someone very afraid. She made whimpering and moaning sounds. I asked her if she was in pain, but she just looked at me. She reminded me of a frightened animal caught in a trap. Her legs were amputated and her arms were weak. She could not turn or move by herself. I told her I would bring her some morphine.

I left the room to get the morphine and catch my breath. I found an aide and asked her to help me clean the women. I was sure by the smell that she had a BM. After I gave the morphine, we turned her over, and what I found was worse than just BM. The patient had a large bed-sore on her sacral area. It was deep and packed with a very foul-smelling dressing that was a dark red, almost black, and brown. It was sutured in place and covered with stool. We cleaned her as well as we could.

When I left the room, I asked the other nurse on duty what that dressing was. She told me the patient had gone to surgery about a week earlier. The doctors thought she was going to die and had packed her wound and sutured the dressing in place. But she didn’t die, and the dressing was forgotten. The terrible smell in the room was blood and stool that had saturated the dressing and was rotting. I could not remove the dressing without a doctor’s order. I was on a unit I had been floated to (sent to work the shift on). I told the charge nurse about the situation. A few days later, the packing was removed because staff were complaining about the smell.

Another patient, on our unit, was a young Hispanic woman. She was only in her 20s, married, with children. She was pretty and very sweet. She didn’t speak English, and she never complained. The whole time she was in the hospital, she only ate a little fruit.

I remember the day she was admitted. She came in because she had a fever. I noticed a brown fluid dripping down her thigh. At first, I thought it was stool, but it was not. Then I thought it must be coming from a wound. I cleaned her leg and looked for a wound but didn’t find anything. As I continued to look for where the fluid had been coming from, I saw more of the same brown fluid oozing out from a crack in the skin. It was not coming from a wound, it was just oozing out. She was started on antibiotics.

I don’t think the doctors took her condition as seriously as they should have. Probably because she was young and looked healthy. Her only obvious symptom was fever, and she didn’t complain about pain. She stayed in the hospital for about 3 weeks and got progressively worse. She had a history of rheumatoid arthritis and had been treated with corticosteroids for a long time. The steroids reduced her body’s ability to fight infection.

She had an infection in her blood, and the antibiotics didn’t get rid of it. The last week she was in the hospital we could see that she was in a lot of pain, and she stopped eating. She died on a Sunday morning. The staff was sad, but at the same time we were relieved that her suffering was over.

November 16, 2000

I am still on staff part-time at the rehab hospital, and at the hospital where I had my first full-time position. But I need to be full-time at a hospital, so I can get health insurance and other benefits. I went to the hospital where I first worked as an RN and asked if they had a position for me. The SNU unit there is closing within a month. All of the staff will have to be transferred to other units. I told the nursing director that I could not work the evening shift, because I need to be home at night with my daughter. I told her Susie is dyslexic, and I need to help her with schoolwork. At first, she said that there was nothing but second shift available. I asked if I could work in the float-pool, but she said that I did not have enough experience. She said that I might be able to work on the oncology unit, but there was no position open on the day shift. I asked about the weekend shift. I knew that the hospital had some nurses who worked 12 hour shifts on Saturday and Sunday, and got full-time benefits. She said there were no weekend day shifts open on Oncology. I asked if I could work weekend nights. At first, she said there were no openings. I was disappointed and said I would have to look somewhere else for a job. She said to wait for a minute, and she called the oncology manager, Sharon. She said that Sharon would be calling me back, and there might be an opening for me on the weekend night shift.

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TWO

ONCOLOGY

February 5, 2001

I am working the weekend night shift on the Oncology unit, and still work 1 or 2 days a week at the rehab hospital. We have 4 nurses on our shift, but we can only use 3, even if we are full. So every shift one nurse has to float to another unit. If we don’t have enough patients for 3 nurses, then 2 nurses will have to float.

The charge nurse on our shift is Ann. She is an experienced nurse in her 40s, with short, light-brown hair, pale skin, and freckles. She has been a nurse for a long time, and she likes to teach other nurses. She would make a good nursing instructor. No matter how busy we are, anyone can go up to her with a question, and she will stop whatever she is doing and find an answer.

After a few weeks, one of the nurses on our shift quit and moved away because her husband was transferred by his job. So now there are only 3 of us left. It’s me, Ann, and Marian.

Marian is a young married woman with 2 little girls. She is from India, as many of our nurses are. Our hospital is part of a large health care system, and recruits staff from India and other countries. She is nice to everyone, and almost always has a smile on her face. She gets tired late at night, and often falls asleep at her computer while she is charting. Her husband calls her a lot while she is at work. I don’t know what her husband calls about, because she does not speak English to him.

Marian told us that she is too busy to sleep much during the day. She said her husband insists she prepare all meals from fresh food. She is not allowed to use anything frozen, from a box, or a can. She told us she usually gets about 2 hours of sleep each day on the weekend. Even though she works Saturday night, she has to get her girls ready for church on Sunday morning, and then fix a meal after church, before she can sleep. Then she has to work a 12 hour Sunday night shift.

She told us that her husband is jealous and abusive. Sometimes she goes into the employee bathroom and cries. But when she comes out, she always puts a smile on her face and takes care of her patients.

February 12, 2001

One of my patients last night was a frail Hispanic woman in her 80’s. She has a large family. When I went in the room, there were about 6 people, well dressed and professional looking. They were all very concerned about her. She complained that the staff in radiology were rough with her and inconsiderate. The nursing supervisor was called and came to talk to the family. When I went into the room, she quietly but tearfully told me about how they had treated her badly. She was so sweet, and I knew she had terminal cancer.

I wanted to do everything I could to make her comfortable. She did not ask for any pain medication, but at about 10:30 PM she asked for something to help her sleep. She said that she had gotten something the night before. She didn’t know what it was, but it helped her to sleep. The only thing she had ordered that would help her sleep was Ativan. But when I tried to get it for her, I noticed the order had expired. It is a narcotic, and I could not give it to her without a new order.

I paged the doctor on call. The answering service called him twice before he returned my call. He sounded like I just woke him up, and when I asked him for the order, all he said was Yes. Then he hung up. I wrote the order and gave the medication to her. About 15 minutes later, he called back. He was angry and wanted to know who had paged him at 11:00 at night, and why he had not been called earlier.

I told him that I was the one who paged him, and I did not know why the day shift had not called him to renew the order, but there was a note for a doctor about it, on her chart. He asked me if I was a regular on the unit, and I said Yes, but I just started a few weeks ago. Then he said in a grumpy tone, Are you all going to need anything else from me tonight? Of course, that is a question I could not answer, but I just said I don’t think so. I told the other nurses, and they said I should have just given the medication and made sure there was a note to re-order on the chart. I told Marian and Ann that I hoped I did have a good reason to call and wake him up again, just because he was such an ass.

February 19, 2001

Last night I only had 4 patients at the start of the shift. One sickle-cell, one cancer, one bowel obstruction that was post-op, and one diabetic dialysis patient who just had a big toe amputated and had a foot wound. I had to do dressing changes on the post-op bowel obstruction patient and the patient with the amputated toe & foot wound.

The patient with the foot wound had a hole about as big around as a quarter on the underside of his foot. It was packed with a dressing that looks like ribbon, and is made damp with sterile normal saline, before packing it in the wound. I try to get everything that I think I will need set up on a sterile area and make sure that nothing becomes contaminated. Then I remove the old dressing with regular gloves. I put on the sterile gloves when I am ready to pack the wound with the new dressing.

The hole in this man’s foot was surprisingly deep. I packed about half of a bottle of ribbon in it. I could have used a little less, but I would of had to cut the ribbon with my scissors. Even though I cleaned them with an alcohol pad, I didn’t want to use them unless I had to. It would be nice if we got a sterile scissors to use for every sterile dressing change, but we don’t. I can see how wounds like this get infected if the nurse changing the dressing is in a hurry. I have seen nurses do the dressing change without putting on sterile gloves, and using