Raging Towards Retirement: The Battles of a Nurse

Editor’s note: The author wrote this essay in the final months of her 40-year nursing career.

As the sun sets on my 40-year nursing career, I am filled with a sense of loss and sadness. I expected these bittersweet feelings. Nothing, however, prepared me for the abject rage and fear I have about night falling on health care in general and on my ancient profession specifically. Sadly, I have ceased encouraging people to pursue it. The Department of Education’s move this year to leave nursing off its list of professional degree programs for federal student loans, a rule a federal judge has since blocked, did not help my dispirited mood. 

My four-decade experience has mirrored all that has gone wrong. Long before the current upheaval in federal health policy, we were in trouble. We are the backbone and the heart and soul of health care. If administration walked out, they would not be missed. If nurses walked out, there would be no hospital.

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Two things led me to nursing. The first was a family story I don’t ever remember not knowing. In 1926, my paternal grandmother, who was mentally ill, was placed permanently in a state psychiatric facility, and my father, abandoned by his father and extended family, was sent to an orphanage at age four. I now know it was the seminal event that led to my desire to be useful in the face of pain, to face the abyss, to know that human contact makes a difference. The second was the young OB nurse at Dartmouth-Hitchcock Hospital who, in 1976, looked me in the eye and said, “You won’t die” as I labored to deliver my breech baby. I knew I wanted to be her. 

And so it began. My first job was at an inner-city Catholic hospital, run by a nun who was a nurse. Even though I was not Catholic, I found “The Hail Mary” broadcast over the P.A. system somehow comforting as I emptied Foley catheters at 6 a.m. Several jobs and two degrees later, I landed in an oncology office working as a nurse psychotherapist. That office is now run by a corporate entity. From nuns to MBAs, there has been no progress. 

I loved my career: the intimacy, the camaraderie, the battles won and even the battles lost. Early on I was aware that being a “good nurse” would often be in conflict with being a good employee. I chose the former, and I was never a favorite among administration. On most mornings at one of my first jobs, our beleaguered head nurse would come around the corner of the nurses’ station with this greeting: “Good Morning Ladies . . . Donna, don’t start.” This same head nurse was the first boss, but by no means the last, to use the ridiculous phrase, “You will have to do more with less.” To which I replied, “I will likely be doing less with less.” Slowly but surely, health care ceased to be about care and became about the survival of an institution, whether a hospital or small medical practice. With each corporate takeover I’ve endured, there has been no improvement for patients.

The first tremor of this earthquake came in the form of coupons. I was working as a staff nurse on a psychiatric unit in a community hospital. One afternoon we were all herded into an auditorium to be updated on the concept that patients were now “customers.” I found this appalling. The word “patient” comes from the Latin “patiens”: to suffer, to endure, to bear. A patient is not at Walmart, and they are not shopping. And yet, we were instructed in the disbursement of “coupons.” Supposedly the mere activity of handing out coupons to unhappy customers would give us a sense of empowerment. See someone crying in the hall? Offer a coupon to McDonald’s or the gift shop. As I write this, 27 years later, I’m even more incredulous. But at the time, I was outraged and raised my hand during the Q&A. An overly coiffed woman in a tailored suit and spiked heels marched up the aisle, pointing her perfectly manicured index finger at me.

“I can’t think of patients as customers,” I told her.

She stared me down and said curtly, her finger still in my face, “And people like you will not last here.”

Spoiler: she was right.

And so I began my countdown in that institution. My anger and dissatisfaction were apparent everywhere, including but not limited to the elevator each morning with the VP who was frequently in a floor-length mink coat. But I remained committed to the work, if not the job itself. By then I was the nurse therapist in the outpatient psychiatric day program. The most onerous part of an otherwise great job was calling insurance companies at the end of the week to ask, beg, or cajole for more days of treatment for our patients. These were patients who, 30 years prior, would have been inpatient for a couple of weeks. Now they got three to five days and, if they were lucky, were discharged to outpatient for five to seven more. One Friday afternoon, I was tired and overwrought as I gave the clinical report on a patient who exhibited the symptom of akathisia.

The clerk, who would make the treatment decision, interrupted and asked, “What’s akathisia?”

I snapped. “Ants in the pants, and if you don’t know what it means, how in the world do you get to decide this patient’s need for treatment?”

Needless to say, she reported me to my MBA boss, who sent me for “re-training.” Fortunately, the social worker in charge of my reprogramming laughed on my second visit and said, “You will never fit in here and you know it.” And away I went to the next chapter: 20-odd years with two part-time jobs, one as a therapist in a hematology/oncology practice and one as a visiting nurse.

These were the happiest years of my career. I had less to do with administration in either job, and it became obvious to me that autonomy was my primary need in order to do my work. In home care, just being in someone’s bedroom or kitchen changed the whole dynamic. Patients often gave me as much or more than I gave them: recipes for Waldorf salad, stories of living in the woods during the occupation of France and hauling water through the Warsaw ghetto. I remain stunned thinking of the glimpse I had not only into people’s lives but into history.

And the great one-liners stay with me. The elderly man with a difficult extended family said one day, “I know I’ll never get in trouble for things I think but don’t say.” One of my all-time favorite patients, who had experienced unspeakable and repeated losses, told me that her method of coping was to say when she woke up each day: “Feet on the Ground.” And finally, a 98-year-old who was complaining about the changes in health care said, “I want a doctor who cares, and if he doesn’t, I want him to act like he does.”

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I skirted along the outside of the system, ignoring non-clinicians who inserted themselves into my practice, until I couldn’t. And then came the final corporate takeover. Maybe at 73, I just have no more patience. Maybe I’m grieving the loss of a system with a heart. Maybe I’m too caught up in my belief that health care is a right to bear the indignity of knowing that it’s now all about the bottom line.

In my final months, I would sit with the doctor with whom I’ve worked for over 20 years and discuss how disappointing the environment was, to have non-clinicians half my age telling me my documentation was not cutting it. One day I told him the takeover felt worse than the pandemic. Back then, we were all united to keep the patients safe, to keep ourselves up and functioning. I told him, “You were our fearless leader and it was scary and exhilarating to know we could keep the doors open.”

Sadly, his response was, “Now this is what has to happen to keep the doors open.” The clarity came like a ton of bricks. When I continued railing about the indignities of it all, he said, with no affect whatsoever, “I’ve never had a problem with you, you’re great, you do good work and your documentation is fine, I think you’re phenomenal… And it’s not enough.”

Soon I will no longer have a job, but like motherhood, I know I will always be a nurse. The spark was ignited 50 years ago when that OB nurse held my hand, locked eyes with me and said, “You won’t die.” She has been with me ever since, and I can only hope that I carried the torch from her to my patients.

Nothing in health care is ever “enough,” but when the system collapses, nurses will still be there, and it will undoubtedly have to be enough.

🤔 Nurses: when has being a good nurse put you at odds with being a good employee? Share your experience in the comments.