Senior Nurse Mentor

My Mysterious Visitor

To my later regret, I didn’t keep a diary of what I’ve been describing here. All I have are vivid memories of certain events that contains clues as to their dating. I almost always remember the patient’s room and a sense of the season. Hem-Onc could get chilly in the winter, and the sun rose much earlier in the summer. That helps. The nurse I was working with offers another clue. One experience often informed another, so that establishes their order. Most helpful of all is feeling the surrounds an event. My last months on Hem-Onc were accompanied by a haunting fear that the war between nurses created risks for our kids. That colored every event. 

That’s how I know the incident with a mysterious visitor came early, perhaps during my first month on Hem-Onc. What I was doing was so new, a nurse that I’d not seen before did not strike me as unusual. Later, I would have been more curious about who she was.

She was about forty and thus older than most. The hospital liked to hire young, so the typical floor nurse was in her twenties, while most specialty nurses were in their thirties. She may have worked in an out-patient clinic. Since she had had come to Hem-Onc in the wee hours of the night to check on something, it was probably the one for leukemia.  Checking on me—the new guy on nights—may have even been one of her reasons. She did go out of her way to talk with me.

She also did more than chat. She confided something surprising. The hospital, she said, had a history of going off on a tangent about every five years. The last time was about three years earlier when its specialists decided their colleagues out in the community didn’t need to be kept informed about patients they’d referred.

It’s easy to understand why that might happen. These specialists were busy. Establishing phone contact with the referring physicians was a hassle. They felt it was better to stay focused on patient care.

On the other hand, the referring physicians knew those children remained their patients and, when discharged, they’d again have to provide care. They didn’t like feeling that when a child was admitted a door slammed in their face with an implied “you’re not needed anymore.”

The result, my mysterious visitor went on, was a boycott. Whenever possible, doctors sent their sick children elsewhere. The patient count fell so low, she said, some units had to be shut down. It was grim.

I had no reason to doubt her, and a few months later I received confirmation. Rummaging in a nursing-station drawer I came across a motivational lapel pin whose slogan was along the lines of “Have You Talked to the Referring?” The hospital had learned a lesson.

During my last, troubled months at work, I recalled that mysterious visitor. Three years before, she had said, and now it was roughly two years later. Her prediction was proving disturbingly accurate.

Another thought troubled me. On Hem-Onc, I had tried to explain the tensions between nurses as a result of the envy that older and talentless nurses (and a head nurse) had for younger and more capable nurses. That made me feel less uncomfortable than the possibility that the nasty, critical attitude originated higher up. That wasn’t true on the teen unit. All its nurses were capable and got along well. Instead, the problems only began when the permanent head nurse returned. As she attempted to set nurse against nurse, morale plummeted. Then I had to face the fact that these head nurses might be responding to signals from higher up.

At this point, some disclaimers are appropriate. First, when I started at the hospital I saw nothing, apart from the poor orientations given to me and the nurses hired a few months after me, that indicated trouble lay ahead. All seemed well. In fact, I saw the opposite. I was impressed by the responsibilities the hospital was willing to assign to me. I was soon teaching CPR and trained to monitor peritoneal dialysis.