August 25, 2009, 10:42 am

Take a Good Look at My Face; You’ll See My Smile Looks Out of Place

funny-pictures-tiny-bird-is-fierceLet’s just say work has been rather challenging lately, so when I came home and found this in my mailbox I had a good laugh!

I feel like standing up and screaming to the world that I am in charge!

Of my life. Of my job. Of my time.

When in reality, I’m just a little “fuzzy” who is trying to convince the world she’s in control.

Well, at least I’m cute.


Warning: the following is not a “happy-happy-joy-joy” post about nursing.  It is a post born of of fatigue, frustration and another “F” word I’ll hold back from using. Happy Peppy Emergiblog will return in another post.  Just not this one.


It’s been hell.

No matter how fast you run, how much compassion you display , how many hours you put in, how professional you behave or how well you perform…

It’s never enough.

More. More. More.

Faster. Faster. Faster.

Now. Now. Now.

Me, me, ME, Nurse! Me, me ME!

Well, there is only enough of me to go around.


I always try to keep my patients apprised what what is going on the department when it gets busy. In a general way, of course.  I make sure they have any medications they need to be comfortable (yep, pain medicine is the priority in my book)  and I tell them I will be back to check on them, when they can expect their test results and, if they are being admitted, what needs to happen before they can go up to a room.

This is especially important when it’s the middle of the night and eight patients needing acute work-ups walk in within one hour.

The patients know it is busy even before I get them settled and informed – hell, they enter the department in groups of three!  They enter the department watching the person next to them vomiting their guts out at the desk.

But it doesn’t matter.

Now. Now. Now.

Faster. Faster. Faster.

Me, me ME, Nurse! Me, me ME!


You know how some hospitals measure their door-to-balloon times for cardiac catheterizations?

Well, I measured our door-to-pain medication times.

Informally. Over three nights.

You know what we average, at night, with bare-bones staffing that would send those who monitor nurse-patient staffing ratios into full blown anaphylactic shock?

Thirty minutes.

Door-to-pain medication.

Thirty minutes.

(That’s why patients come all the way from the far reaches of the Bay Area to see us instead of World Famous Medical Center With Attached Medical School Where They Will Wait Hours and Hours.)

And it still isn’t enough.

Now. Now. Now.

Faster. Faster. Faster.

Me, me, ME, Nurse. Me, me ME.


I’m a damned good nurse.

I pride myself on my patient care.

I can take more curves thrown at me, tolerate more patient idiosyncracies and deal with more challenging personalities than anyone I know and do it all with a smile on my face.

I understand that when someone is acutely ill (real or perceived), they tend to turn inward. What is going on around them is not necessarily in their sphere of awareness.

But if they are:

alert and oriented

evaluated and medicated

settled and informed

and their senses are intact…

When they can see and hear that the department is full…

When they can see and hear that more patients are arriving on foot and by ambulance…

When they can see and hear that the nurses are running their asses off…

And all I hear is:

Now. Now. Now.

Faster. Faster. Faster.

Me, me ME, Nurse! Me, me, ME

….well, that is just flat out wrong.


My god, people, look around you!

Call me a horrible nurse, a burned-out witch  or accuse me of having no compassion for the sick,

It can’t be any worse than what I’ve been dealing with lately.

And I’m flat out fed up.

But I have no choice but to keep on going.

With a smile on my face, of course.


with a smile on my face.


  • Julie

    August 25, 2009 at 11:16 am

    There are times in your life when you realise – enough. Maybe this is your time, perhaps it is time to find new challenges. Mean time, I have always considered nursing to be oscar winning actress work!

  • Candy

    August 25, 2009 at 12:00 pm

    You know how much I’ve always wanted to be in your shoes…but maybe it’s time to trade in those Crocs for something else. You’re almost done with school, so maybe this is the time to concentrate on that and look to your very bright future. The kids are settled and NO ONE should live with the dread you have in the pit of their stomach. There are other places to practice, woman…and other choices for your own mental health. Trust your own instincts.

  • Laney

    August 25, 2009 at 12:29 pm

    Rock on! You’re our inspiration. And when the patients get crazy and needy, just take a couple of deep cleansing breaths.


  • ArtDoctor

    August 25, 2009 at 1:44 pm

    You sound like an excellent Nurse— one that any patient would want to have for their care.

  • Rachel

    August 25, 2009 at 4:12 pm

    Your post made me realize that as an accounting clerk in a small company, nothing should be a dire emergency. And yet, the powers that be determine otherwise.

    Keep your emergencies there where they belong, please. (Only if you really truly want to stay there, of course.)

  • Carol

    August 25, 2009 at 4:41 pm

    I remember sooo well days like those. I feel for you, I really do. One day we were so busy on our unit that I was forced to stay over for a 12 hour shift. None of us got a real break that day. We just grabbed a cup of coffee here and there. It was the end of my shift and I could hardly think or talk any more. All of the patients could tell how busy we were. It was one of those nightmere hellish days. This little lady hands me an empty coke bottle and says “My flowers need watering.” LOL Of course I stopped what I was doing and watered her flowers. She was one of the few patients on the unit who could get up and walk. I don’t think anyone who is not a nurse could possibly understand how hard we work.

  • NPs Save Lives
    NPs Save Lives

    August 25, 2009 at 5:02 pm

    Kim, I can feel your pain. Not working in the hospital setting anymore, but it is getting REALLY busy in the office (be careful what you wish for!).
    Some days I work half way through lunch and spend hours of home time catching up the chart work and writing referrals for testing (routine mammos and colonoscopies mostly) but tedious. I LOVE MY JOB! Really, I do. Not being facetious at all. Hang in there!

  • AlisonH

    August 25, 2009 at 6:24 pm

    And this is why I, three weeks ago at WFMCWAMS for five days, was trying to tell my nurses thank you but I’ve actually had that bag eight months now, that wasn’t what this surgery was, it isn’t new, I can take care of it and you don’t have to…

    Oh. Right. Not ambulatory yet. Well, but, can’t I still, and give you a break?… (Nope. Not one let me. But I tried!)

    I agree with ArtDoctor. Any patient who gets you has lucked out totally. And I can say that.

  • Julia

    August 25, 2009 at 7:17 pm

    Not every night is crazy. Some are more then others. You are an excellent Nurse. Do not give up. Just take extra Ambien and get extra sleep.

  • Laura Scarborough
    Laura Scarborough

    August 25, 2009 at 9:26 pm

    once again you so easily put into words what so many of us feel while in the nursing trenches no matter what department of the hospital we work in. it’s good to acknowledge this i believe.
    thank you, Kim.

  • Ken O
    Ken O

    August 26, 2009 at 4:46 am

    Consistently 30 minutes or better from door to first treatment in an ER is seriously d@mned impressive going. You have nothing to be embarrassed or fed up about other than feeling unappreciated, and that happens to us all sometimes. {Kim}

  • Stina

    August 26, 2009 at 6:43 am

    Wow Kim that was really well written and really sad all at the same time. I wish I could give you advice so that you would feel better, but at this stage I think I can only learn from you. Thank you for being an inspiration to me. 🙂

  • Paris

    August 27, 2009 at 8:47 am

    Kim, thank you for sharing this. Hope you can take time just for yourself soon.

    The world is lucky to have you.

  • JodiP

    August 27, 2009 at 8:18 pm

    Hang in there Kim. I’ve been there and still can get there from time to time. You can only do what you can do and sounds like you do a phenomenal job. Thanks for all you do and thanks for great posts

  • The EMT Spot » The August EMS Roundup
    The EMT Spot » The August EMS Roundup

    August 29, 2009 at 4:35 am

    […] Kim at Emergiblog rants about the very human but sometimes selfish pursuit of need in The Smile on My Face. Epijunki revives an old cartoon series to good effect in Goofus and Gallant, EMS Edition and […]

  • Lisa Emrich
    Lisa Emrich

    August 30, 2009 at 4:15 pm

    The last time I went into the ER was about 4 years ago when I was pretty sure that I had developed shingles. Not really an emergency, but those blisters waited until 10-11PM to start to truly emerge. I’d had pain, itchiness, and a rash developing during the day.

    I already knew that the sooner one started anti-virals, the better. So I took my pillow with me to the ER and a book around 12AM. I expected a very long wait since it wasn’t really an emergency and I just didn’t want to have to wait until late the following day to ‘maybe’ get in to see my doctor.

    It was the fastest and shortest ER visit EVER!! Even with calling an opthalmologist to look at my eye because the rash was surrounding this area, I was out of there in 45 minutes with prescriptions in hand.

    Doctor asked what was going on – I pointed out my face. He asked me what I thought it might be – I said it looks like the shingles my mom had had years before. He said – You’re correct and we should get you started on some anti-virals.

    I don’t know. Maybe the presence of a pillow from home helped to spend up the process. That and the non-complicated case.

    I feel for ya. ERs in the middle of the night (always the time my mother feels the need to go) can be brutal.

  • TC

    September 3, 2009 at 9:05 am

    I had a shift once where literally we were coding someone in the middle of the ER and people were like, walking up to the nurses’ station going, “Where’s my nurse! I need a drink of water!”

    Hello! I’m over here doing chest compressions!

    I think the busier it gets, the more scared people get, thinking, “oh my God. There NEVER going to get to me.” How I miss the ER.(NOT sarcastic).

  • Maureen

    September 3, 2009 at 1:50 pm

    I wish I lived near you because I have never experienced the kind of care you give. If I had, I would be on my knees thanking you, not saying ME, Me, ME or More, More, More! You are an awesome nurse (and person I might add), don’t let the idiots bring you down to their level and know there are patients out here who would feel blessed to have you caring for them!

  • Sean

    September 4, 2009 at 12:35 pm

    You need some good ‘bounce back’. It’s tough. Bottom line. No quams about it. And sometimes, just sometimes we find out we’re human and well.. it gets to us.
    It’s OK Kim.
    We all have that ‘Oh- crap I’m human’ moment.
    The great thing is.. we all know it’s temporary.
    Stay strong Kim.

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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