The nurses caring for the very ill here come from all walks of medical life; the ER, the ICU, specialty outpatient clinics, and even neonatology. They bring diverse sets of skills and experiences, and have diverse range of aptitudes. This is true anywhere, but magnified in a situation where the staff is generated collectively from hospitals all over the country, and really, the world.
There is one nurse who works in the ER, and moonlights in a catheterization laboratory. She is reasonably skillful, but has an exagerated sense of her own skills, and commonly questions orders from all of the physicians. A quest for edification or education is fine, but it becomes tiresome to explain alternative ways to do things right to someone who seems to have been trained in a singular, but apparently superlative fashion. It is worth noting that being awake and alert in the ICU is enough to drive anyone bonkers. After asking this nurse to provide the alert and non-sedated Iraqi patients with some kind of Arabic media (TV, magazines, etc) for the past several days without a response, I decided to write my request as an order in the chart. She didn't like this, and thought it was patronizing. My retaliatory order was: "Please make balloon animals for patient." She didn't like that either.
Another of my nurses clearly graduated at the top of her class, though this could not have been more than 3-4 years ago, as she looks no older than 25. She is demure, and keeps away from some of the more outspoken of the staff (see above), and spends her time reading or providing extra comforts of some kinds to the patients. As I was coming in to work the other day, she was walking toward me, on her way home with fresh tears in her eyes. Apparently, a young soldier charge or hers tried to hang himself with his IV tubing when she walked around the corner for some supplies. This was averted, and obviously awful. The dayshift carbon-copy of the RN in the previous paragraph saw this as an opportunity to disgrace her, by filing the infamous "incident report," (of which there is likely one being generate in my file for the balloon animal comment in the medical record). My young friend, blaming herself for this misgiving and near tragedy, had the compound guilt of underperformance or making a near disastrous error (walking away from bedside for 5 minutes?) in the face of a senior, and markedly inferior, nurse.
It really is like General Hospital minus the sex. Politics and drama.
When people ask me what I actually do here, my response is that I do very little, but write a lot of orders which other people execute, and for these nurses and technicians who clean, maintain, and comfort these patients; who administer medicines, shepherd through rehabilitation, and organize important medical documentation, I am grateful to thee. For those of you who go the extra mile in care of your charge: I am inspired.