When Nurses Become Patients

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We don't know how not to be calm and in control.

nurses as patients.jpg
"Patriotic nurses for South Africa" 1899 (Flickr / State Library of South Australia)

I didn't figure this out until last summer. I was at a friend's place helping her move out some old furniture. Right after I lifted her hardwood coffee table, it broke apart, and the heavier piece dove straight onto my toe. After the initial shock, the pain hit, and then the picture was not pretty. I hopped around the living room erratically, alternating between standing and sitting as I tried to find some position of relief. I kept muttering phrases to my friends like "you guys just need to relax" and "calm down, everyone just calm down." They observed in silence, wide-eyed.

After several laps of limping, I ended up on the couch with my foot propped up. My friends put a frozen bag of peas against my toe and then finally said, "We are calm Shazia. YOU need to calm down."

I looked at their faces, stopped my sighing short, and thought about the situation at hand. They were right. I had kind of lost it.

His plan to over-hydrate himself was not the right or safe answer, but luckily he woke up at 4 AM with an overwhelming urge to relieve himself.

As a pediatric critical care nurse, I deal with my fair share of screaming toddlers, stressed parents, and anxious kids. We hold the hands of children as they undergo painful procedures (sometimes at the cost of adequate circulation to our own hands). There are always worried parents who need reassurance that we are doing everything possible for their sick child. And during the most unpredictable of emergencies, we maintain a cool composure in hopes that the patient and our colleagues will follow suit.

Basically, calming down panicked people is a huge part of the job description. But when that table hit toe, my role had reversed. In hindsight, of course I see how ridiculous I was acting. And that got me wondering more generally about when nurses become patients. How do they handle being in the bed, as opposed to at the bedside?

Turns out that many do not handle it well. After talking to a few co-workers, I realized that nurses can be some of the worst patients. My personal opinion is that it's a dysfunctional coping mechanism; we don't know how NOT to be calm and in control. So the rare times that we don't feel those ways, we project our anxiety through behaviors that are just as unfamiliar to us.

To put it bluntly, we can be kind of obnoxious.

Take, for example, my coworker who was in the hospital and put on a medication that had possible side effects of nausea and vomiting. The doctor's orders stated to give anti-nausea medication if needed--only for if and when the patient displayed the symptom. But my coworker decided that her orders superseded the doctors---a classic mindset of nurses who become patients. She had no intention of feeling any of the side effects.

"I want that anti-nausea medication around the clock. I don't want to have to call you. I don't want to have to wait for it. I want it every six hours, on the dot," she demanded from her nurses.

Some of her nurses initially protested, saying the medication wasn't supposed to be given preventatively. Others knew that it was a battle not worth picking. Regardless, she got her way and spent the entire hospital stay without feeling any nausea. Or making any new friends.

In other cases, we see nurses taken out of the hospital environment but not able to let go of hospital policies. One PICU nurse went to her primary doctor after a few days of coughing, congestion, and fever. In our unit, there are a lot of children with multiple underlying health issues. We usually respond to a fever and respiratory distress with a series of tests to pinpoint exactly what the cause of those symptoms are. But when an otherwise healthy person shows a mild presentation of these symptoms, the first line of treatment is usually a round of antibiotics. That is exactly what her doctor prescribed after a thorough assessment. But my coworker had a hard time being 'written' off, albeit as a prescription.

"But ... are you sure you don't want to take a chest X-ray?" she inquired, followed by a strategic cough.

The physician smiled and nodded, explaining to her why he deemed an X-ray unnecessary at this point. She wasn't convinced but let it go. As they parted ways, she made sure to take some purposefully labored breaths. Just for emphasis.

Her case of the common cold was cured within a few days--without any unnecessary exposure to radiation. In the back of her head, she knew her request was unreasonable. She just didn't know how to do anything other than what she was used to. Other nurses also admitted to parallel behaviors in primary care settings--the urge to impose hospital protocols isn't easy to shake.

It's also not unusual to find nurses believing that they are above the rules when the tables turn on them. One rule we reinforce to patients and families is not to touch or handle the pumps and machines around them. When one of my colleagues had still not gone to the bathroom twelve hours after his surgery, his nurse and doctor discussed inserting a foley catheter--that is, a tube through his urethra into his bladder to drain it.

"I totally respect your profession. But I would feel more comfortable with a physician intubating me."

"Give me until 7 am. If I don't go by then, you can put it in," he bargained.

They reluctantly conceded. As soon as he was alone, he reached to the pump that was infusing fluids through his IV. After a fleeting pause of guilt, he cranked up the rate to 3 times what it was set at. His plan to over-hydrate himself was not the right or safe answer, but luckily he woke up at 4 AM with an overwhelming urge to relieve himself. He knew it didn't necessarily happen as a result of his medical manipulation, but was desperate to avoid any discomfort down there.

Nurses also make their caretakers work hard to earn their trust -- harder than they really need to sometimes. One of my coworkers has no shame in interrogating her own doctors on their credibilities, and doesn't take them seriously unless she approves of their medical school, residency, and fellowship (fellowships are a given in her book). Another nurse I work with frequently trains new graduates and employees. When it comes to education and advancing the nursing profession, she is always at the front line.

Except when it was her turn to have a breathing tube placed for a surgery. As she was signing consent for this, she looked suspiciously at the badge of the woman obtaining her signature. The woman was a nurse anesthetist.

"I totally respect your profession. But I would feel more comfortable with a physician intubating me," she said.

The nurse anesthetist was slightly taken aback, but offered to speak to the fellow to see if he could do it.

"Actually I'd like the attending to do it," my co-worker responded.

So much for promoting the nursing profession. Or even encouraging the general endeavors of a teaching hospital -- she dismissed every step on the learning ladder by only trusting the attending.

But in this scenario, she was on the receiving end of care, and totally out of her element. Just as I felt when that coffee table fell on my toe. Our comfort zone is nurturing patients and serving as the foils to their fear. When we step out of it and into a position of fear ourselves, we lose our way. Some a little more than others. And some not at all. But for those who do, their healthcare providers should remember -- nurses are generally good, warm, loving people. They might just have passive-aggressive tendencies when they feel anxious, that's all.

As for me, I'd like to think I learned from their stories. If I am ever in a state of vulnerability again -- or rather, when I am -- I'll do my best to stay calm and cool, to be an easy patient. 

As long as everything goes my way, of course.

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Shazia Memon, RN, CCRN, is a pediatric critical care nurse in New York City.

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