Healthcare’s Invisible Glue
I once had the opportunity of developing intimate relationships with people of all ages and from all walks of life. They and their loved ones often shared deep secrets and lifetime memories.
Challenges arose daily, imploring me to make an individual more comfortable or free of pain or to help someone deal with an emotional crisis. As the years progressed, I found that a simple touch, a deed, or a word could profoundly affect the people I cared for.
You may be thinking, “You must be a nurse, right?” No. “Oh, then you’re obviously a doctor or an intern?” No, but close.
I’m talking about life as a nursing assistant, better known by the pseudonym “aide,” “orderly” or “attendant.” Their work with elders in convalescent homes is legendary. Legendary because they continue to work in such facilities with little pay, dangerous understaffing, and terrible supply shortages.
Conditions are frequently better in acute-care hospitals, but even there they are often seen as appendages to doctors and nurses. Rare is the individual or organization that grasps the importance and necessity of their involvement in the healthcare system. They are the “meat and potatoes” of hands-on medical care in this country, the glue that holds it together.
Nursing assistants make a crucial difference in peoples’ lives. Frequently, they spend more time with patients than nurses and doctors combined. For some, their presence means the difference between fear and loneliness and even life and death. They are there when we hurt, sweat, laugh and cry.
Some individuals (healthcare professionals and the public) act superior or snobbish to aides, treating them as if they are lacking in brains or have no motivation to “move up” the social ladder of medicine. It’s not overt or cruel prejudice, it is a basic disregard for the job, the training required and the workers involved.
Let me take you inside the world of a nursing assistant for just one 8 ½ hour shift, when I used to work the swing shift on the cancer unit of a local hospital. This is the real stuff, the nuts, and bolts of healthcare and healing. It’s what nurses used to do before they become inundated with paperwork, passing medications and running madly to finish all necessary procedures and treatments and to fulfill all the other responsibilities demanded of them.
After receiving my list of assigned patients and finding out which nurse I’m working with, I begin obtaining patients’ vital signs and get an overall picture of how they’re doing.
The gentleman I encounter in the first room needs his oxygen adjusted and some fresh water and towels.
The next patient, Alice, needs an entire bed change. A 73-year old woman with breast cancer has become incontinent and soiled her gown and linens. She is embarrassed and painfully apologetic. As I cleaned her up she spoke of her fear that she was beginning to lose control of her life. When I left, Alice said she felt “clean, fresh, and renewed.”
The third person I contacted that evening was Charles, a 60-year old man with leukemia. As we conversed, he asked if I was in training to be a nurse. When he found out I wasn’t, he said, “Oh well, this is a good job for you to start out with for your future.” Just then the charge nurse came in with a frantic look on her face and asked if I could get another patient on a gurney to go downstairs for x-rays.
After I located a gurney on another unit and got the patient ready, another nurse requested that I make a trip to the blood bank to pick up some packed cells (blood). When I returned from the lab, I found my team leader (nurse) at the medicine cart.
We sat down and looked over the “care” charts to decipher what protocol was desired for each patient. Some vital signs needed to be taken and some patients needed to walk, be turned, bathed or catheterized (a tube put in the urethra to empty the bladder). Others had doctors’ “orders” that entailed checking blood sugar levels or collecting sputum, urine, or stool samples for lab tests. During the report, the nurse suddenly stopped, turned excitedly toward me, and said, “When are you going to nursing school?
You would make a great nurse.” She looked downhearted when I explained that I had no desire to be a registered nurse or to go back to school. She said, “But you’re so intelligent!” I grimaced and said, “Thanks”. Was she implying that that nursing assistants are stupid?
When the report was over, I finished the remaining vital signs, lifted one patient up in bed, helped another to use the bedpan, and took Alice for a walk down the hall. While shuffling along we pretended we were dancing to, “Tea For Two
I informed the nurse that a patient’s IV (intravenous bag) was almost dry and that a number of people had requested pain relief and various other medications. The dinner trays arrived and after checking to make sure they all matched each patient’s diet, we passed them out. One of my folks needed help eating (as a result of an old stroke), so I sat by her bed and slowly gave her a few mushy bits of her soft diet, so she wouldn’t choke.
Meanwhile, a patient undergoing chemotherapy was throwing up just two doors down the hall. After emptying his emesis basin (vomit container), I went to supper. Believe it or not, I was famished. It had been only two-and-a-half hours since my shift had started, but it felt like two and a half days!
On the way to dinner, I picked up a magazine that had a feature story entitled, “What Do Nurses Want?” I got my hot, soggy food, set my tray on the table, and turned on the television. The channel I selected dramatized the story of a big-city hospital. As usual, the only characters given any airtime were, you guessed it, doctors and an occasional nurse. Everyone else in the show (housekeepers, technicians, secretaries, and nurses aides) were shown as auxiliary personnel who did nothing but get in the way of the featured players.
After devouring my food in the allotted half-hour supper break, I returned to the unit and picked up the patients’ dinner trays. As I walked by Room 264, I saw Sam (a patient with advanced renal failure) falling headlong towards the floor. I leaped through the door and grabbed him just in the nick of time. Sometimes I felt like I was in one of those old commercials were people dove to catch a spill before it hit the carpet.
Sam was getting more confused and said he had to go get things ready for the rabbit cage. I maneuvered him back to bed and eventually convinced him to stay in his room for the rest of the night. It took another hour before he realized he was in the hospital, after frequent reminders of who, what, and where we were.
Then Michael put on his call light and literally screamed for help! Michael was a young man with AIDS who was in the hospital for treatment of a lung infection. Upon entering his room I found him tense, angry and perspiring profusely.
He asked various questions about medications, IVs, and food. Everything was worrying him. Was this working right? Was that being done on time? Was he getting the proper nourishment? After sitting and listening for a few minutes, it was apparent that he was concerned about something other than mere food. At first, I answered his questions, then I asked him if he could tell me what he was really afraid of?
He began to cry. He said he was overcome with feelings of abandonment from a dear friend and the emotional loss of some of his family members as a result of his illness. Fifteen minutes later Michael and I were laughing about the absurdity of life and the beauty of loving and sincere friendships. He only rang for assistance one other time that evening, to have someone turn out his light and say goodnight.
I left Michael’s room, made a fresh pot of coffee for family members and staff, fixed someone’s bed and TV, and then took Jackie her evening snack of fruit and juice. Jackie and I had known each other for a few years, as she’d had frequent admissions for chemotherapy, such as her present three-day stretch. She always called it her “dose of poison” for the month and described her hospital visits as, “A working, masochistic vacation!”
We spoke of her family, hopes for a cure, and her latest garden project. Then she asked about my children and work. After a pause, the familiar questions began. “When are you going to go study medicine?” “Isn’t this just a job you’re doing to get through medical school?” Patiently, I said, “No, I’m not going to school right now.” It seemed futile to explain once again that this was my profession.
The remainder of the evening involved collecting and measuring fluid totals from each patient and spending time with the family members of a man who died at 9:00 p.m. His death was not unexpected, but the grief his family experienced was far greater than they had anticipated (as is often the case). We called the doctor, minister, and mortuary. I got his body ready by taking out the IVs, putting in his teeth, and folding his hands on his chest with as much dignity as possible.
I finished charting on all the patients around 11:30 p.m., said goodnight to my co-workers and friends, and called it a night.
Another “routine” shift had passed. As I drove home in the darkness, I thought about the perceptions people have of nursing assistants. Our society says it cares about the young and old, yet it places little value on those who care for the sick and aged or teach our children. Such failure to match words with deeds is, at the least, hypocritical.
Why don’t people respect and reward those providing the hands-on care of their father or mother as much as they value the doctor who diagnosed the illness or the nurse that starts the IV or hands out the pills? If appreciation for the work nursing assistants’ do is ever acknowledged by good pay, healthy and safe staff to patient ratios, and mutual respect, I think I’ll pass out from the shock.
Doctors and nurses are prime assets in delivering good quality healthcare. Without them, many would flounder and perish. I’ve seen them work long hours with great heart and dedication. But they are not the sole providers of care, nor do they have an exclusive patent on providing expert and passionate service.
They do not work in a vacuum devoid of others’ energy and skills. Without secretaries, housekeepers, laundry workers, department managers, volunteers, and countless other technicians, assistants, and personnel, the healthcare system would find it impossible to function, let alone provide adequate or quality care.
Life tends to go in circles. Who will be there when you are feeling sick and miserable or someone in your family is? A nurse, maybe. A doctor, perhaps. Most likely, it will be one of my colleagues, a nursing assistant