How to Lose a Nurse

The call to nursing came the summer my 15 year old daughter had a leg injury that landed her a desk job in a Nicaraguan clinic during a church mission trip to Vida Joven in the mountains north of Managua. Instead of joining her fellow teens in camp activities (made difficult enough even without a leg in a cast by the weather, terrain and primitive conditions), she joined a group of doctors and nurses that set up a temporary clinic to provide medical care to people in neighboring villages. Families, often towing five or six shoeless children, walked as far as ten miles to see the American doctors and receive much needed medical treatment for ailments ranging from intestinal parasites to skin fungus to respiratory impairments caused by sleeping in enclosed tarp huts where kerosene is burned to warm the chilly mountain air. Babies with birth defects, children suffering from malnutrition, young men with malaria, diarrhea, festering cuts – curses of the poor in developing countries.

My daughter spoke Spanish well enough to facilitate conversations between the doctors, nurses and patients. And she was put to work dispensing medications – everyday drugs we take for granted but precious to those that suffer while waiting months and months for the clinic to come to Vida Joven. She came home that summer eyes wide opened by the abject poverty of the people living in the western Hemisphere’s second poorest country.

She went back to Nicaragua every summer of her high school years, taking on greater responsibilities in the medical clinic and growing in the conviction that nursing was what she wanted to do. Back at home she searched for a university with a nursing program. She spent spring breaks and summers off building an orphanage in Boliva, nursing at a hospital for women and children with AIDS in Kenya, volunteering at a clinic in La Paz. One day she said to me, “Mom, I was born to be a nurse. I just didn’t know it until now.” Now being the day she came across a tiny rain-soaked boy of four or five stooped and shivering under a tree in Nicaragua – shoeless, hungry, sick. Something clicked for her. And six years later here she is – RN, BSN.

Last night she called me – distressed, angry – wanting to quit her hospital job of just one year after spending another twelve hour shift trying to care for too many critical patients with too few staff, missing supplies, inoperable equipment and physicians that don’t return calls when their own patients are heading south. Concerns tumbled out. The evening she couldn’t get the doctor or charge nurse to believe that her patient was septic (he was). The day that she held tight to a hypothermic patient using her own body warmth to try and raise the woman’s temperature because there were no warming blankets on the unit and no one to search for any. The night just six months out of school when she was the senior nurse on the floor. The critical care patients admitted to med/surg beds without the monitoring equipment or staff to keep them alive. The psych patient admission that punched her in the face. That one shift when the unit had twice the staff (‘don’t get excited,’ said the charge nurse, ‘it’s the show for JCAHO’), the next day when they were all gone. The countless meetings where nurses were invited to share their concerns and ideas. The weeks that ensued where nothing changed.

Her panic was palpable; seated in the fear that her patients are in harm’s way of a system that is just plain broken. And I heard what she wasn’t saying out loud.

That even in the jungles near Matagalpa, even in the slums of Nairobi, even in the makeshift clinics where a handful of professionals and a dozen suitcases of medical supplies somehow divide like fishes and loaves – she never felt as powerless or worried for the safety of her patients as she does in this nationally-ranked, Magnet-designated hospital.

And that breaks my heart.