Pavlovian hubris.

I often think, with bitter irony, that I would have done well emotionally in an ICU three years ago as a new nurse (god, has it been that long in this godforsaken job?!) due to being a much feistier soul who hadn't yet been beaten down not only by the insufferably cruel Way Of The Hospital, but the endless death-dance I like to call the Stepdown Shuffle: "Wait and See."

After playing "The Wait and See" game for three years, often with docs and coworkers too busy or burnt out to care, in a system set up to fail, I've gotten a good feel for well... my ass, because I'm always reaching around to make sure it's still firmly attached, and not about to be kicked into oblivion.

I've also gotten a sense of how much bad care a patient can tolerate, frankly, and in some cases, it's absolutely amazing how sick you can let a patient get before they code and die. I'm talking weeks of a slow shuffle to a miserable death.
So, experienced stepdown nurses--we don't get too fussed about crappy numbers sometimes because well, in the past, when we got fussed about them, guess who cared? Like one other person, maybe, who was a sympathetic coworker, but not anybody who could actually fix the problem.

I learned to "front" and manage the problem, and on the rare floors where I had good staffing and charge nurses to help me, it usually didn't become a crisis. On bad floors, with none-of-the-above, I just knew my patient and I were doomed to a crappy shift.

My point is not that I'm a bad, uncaring person or nurse, and that I should clearly try harder, it's that I have tried harder, I have cared. As nurses--we all have (except for those random, scary ones who seem to be leftover patients from electro-convulsive therapy of the 1960's gone badly wrong). It's just I've found, like so much Pavlovian hubris, that caring and trying to be a good nurse frequently doesn't matter.

So, I've adapted, maybe I've matured, maybe I've just become more realistic about the nature of health care.

So, maybe I don't get as excited when I see numbers drop incrementally, marginally, for a few seconds. I keep having to remind myself that ICU nursing is all about treating the numbers, and if I don't act like the sky is falling every twenty minutes (without, however, giving an impression of hysteria or mania, which would likewise signal I'm a crappy nurse) I'm going to be viewed as a Bad Nurse.

Three years ago, I would have been all over this kind of care, because new nurses are good at nothing if not freaking out about bad numbers.

I'm not saying I'm a lackadasical nurse or I purposely suck at my job because I'm too tired and burnt out to do it properly--I"m just saying the ICU Kultcha Klub can be difficult to wrap my head around at times, and it would have been nice when I was a little less jaded about What We're Actually Doing For People, to see action and response when I had concerns.

Now, after being conditioned into a slave-like mentality at work, my main goal now is to grind through a shift with minimum harm to my patient or self, without stepping on anybody's toes or pissing anybody off (not easy to do in a veritable mine field of hair trigger, bombastic egos and operatic tempers). Not that I care that much about pissing people off, but what I've found is pissing people off leads to me in spiritual meltdown-mode for the rest of the day. I used to sort of have this balls-to-the-wall approach to people who put me down, and now I just kind of take it, almost without carping comment, just to save my energy for the next fake nursing or medical crisis.

And so, in between all these battles and power plays, I sort of gave up on the Militia Woman Nurse model, and opted for the I'll Do Whatever You Say, Whenever You Say, As Long As It Doesn't Appear To Kill the Patient Faster model, otherwise known as Apathy Nursing.

If this sounds distasteful to you, it's probably because it is, and I can only argue self-preservation, not to mention point once again to the sinking, burning, death-trap of a Titanic which is American health care, and plead that it was like that before I ever got on board, honest to God.

Where does that leave me now, professionally and ethically?

I'm still trying to work that one out.