An Open Letter About Nurses “Playing Cards” – Kim S., FNP

This past week, a Washington state Senator, Maureen Walsh, decided to comment on nurses who “play cards almost all of the time.” A huge backlash of comments by nurses, patients, etc., transpired.

I took a break from Facebook and social media for Lent. It’s not that there was a particular reason, but I knew my “screen time” was up in recent months, and I figured that taking a break would help me focus on other things. It worked. I read several books, participated in other activities – all went well. I went on a vacation cruise with my husband, getting back a few days before Easter. I kept to my oath, not looking at Facebook.

Come Easter Day, after our church celebration, I logged back on to the social media quagmire. And what should appear in my news feed?

“Washington State Senator Accuses Nurses of Playing Cards”

So, to briefly recount this idiocy, Washington state senator Maureen Walsh spoke at the Washington state Senate floor debate on April 16^th on Senate House Bill 1155, a piece of legislation requiring health care providers to give clinical employees uninterrupted meal & rest breaks during their shifts, except in emergency situations. She also supported Amendment 724, put forward by her Republican colleague State Senator Curtis King. That amendment exempts Critical Access Hospitals (CAH) from this requirement.

The Center for Medicare and Medicaid Services lists these CAHs as smaller, < 25-bed isolated/rural hospitals that receive certain federal financial support and benefits to ensure ongoing sustainability.

Senator Walsh supported the exemption of CAHs from the meal and rest-break requirement, stating their staff was not typically as busy as other hospitals’ staff.

In her comments, she stated that “by putting these types of mandates on a critical access hospital that literally serves a handful of individuals, I would submit to you those nurses probably do get breaks. They probably play cards for a considerable amount of the day.”

She also referenced the fact that nurses working 12-hour shifts wanted those shifts, yet complained about not getting their breaks. Sort of a “have-your-cake-and-eat-it-too” philosophy.

The backlash from national, local, and in-the-trenches nurses has been brutal and fierce. AND, IMHO, well-deserved. I well remember my ICU and OB-GYN days, working 12-hour shifts, where a bathroom break – much less a meal break – never happened. Twelve-hour shifts were a joke, because there was always AT LEAST another 1–2 hours after the fact to chart. Because, you know, “if it isn’t documented, it wasn’t done.” Not to mention that management often chewed us out because we incurred OT hours to chart. Oh yes, the sentiment was, “you’re not managing your time well-enough.”

So my response to Senator Walsh is as follows:

Senator Walsh, your misguided comments hit a vital nerve. I daresay you broke Joy Behar’s record for loathing after her seriously misguided, “doctor’s stethoscope” comment on The View. What boggles my mind is that your own mother was a nurse.

(Now, mind you, I’m sure in her day, nursing responsibilities were nowhere near what they are today. Given her age, likely, she was in the era where one heated up morphine in a spoon, stood up when physicians entered the nurses’ station, giving up your chairs, etc. Her nursing care may have been what has been relegated to nursing assistants today. I’m not sure. There have been no references to her experience.

Let’s face it: medicine and nursing is LIGHT-YEARS away from that time in acuity, stress, and personal threats. We ALL have witnessed this change in medicine. I’m not sure I would have ever remained at the bedside, now that I’m almost 18 years out since becoming an NP. The changes have been devastating to many bedside providers.)

So, Senator Walsh, when you add in your poorly-chosen words, in the so-called interest of protecting these CAH facilities, you did your constituents – indeed, ALL nurses – a huge disfavor. How difficult is it to recruit nurses and physicians to these hospitals? I’d bet – virtually impossible. Most professionals don’t envision working in a super-rural area, with a small hospital, limited resources, etc.

Senator Walsh: you owe ALL nurses an apology for your insensitive remarks. You state you were “tired” when you made those comments. I daresay you don’t know the meaning of fatigue unless you’ve worked a non-stop 8-hour or 12-hour shift of a nurse.

You should spend a day working next to a nurse who does JUST THAT. You’ve reportedly said you’re willing to do so. I want to see a documentary following you, and getting your input after such a day. My guess is that you’ll be sitting down (is there such a thing in nursing?) within two hours. If you DO manage to follow a nurse for 12 hours, please, write a post stating what you learned in that long day. How YOU propose to change your thought processes, and more importantly, amendments affecting nurses (and ultimately, the patients) in your state.

I’d bet you’ll be more willing to allow mandatory rest breaks after that experience.

So here is HOW we nurses DO play cards, and really, it is all about maintaining a “poker face”:

1. We keep a poker face when we’ve learned about a horrible test result, e.g. cancer, but we can’t share it with a patient until the physician does (not in my NP practice, but it is true as an RN).
2. We keep a poker face after doing postmortem care on one patient, then immediately going in to care for our living patients.
3. We keep a poker face when patients/families scream at us, abuse us, and physically lash out at us.
4. We keep a poker face when physicians or other health providers scream at us, get up in our faces, and demean us in front of others.
5. We keep a poker face when management tells us that we need to “work smarter, not harder,” yet there isn’t enough staff to do just that.
6. We keep a poker face when we have personal or family issues that would normally break a person – yet we have to keep working, moving on, being compassionate, etc.
7. We keep a poker face when yet another administrative “big-wig” tells us that we now have to “check more boxes” to meet mandates and/or get more reimbursement.
8. We keep a poker face when we have to orient yet another co-worker, because our previous ones left in frustration, thus adding to our work burden.
9. We keep a poker face when we read emails about yet-another promotion for someone in the “ivory tower” of medicine. Someone who is making four or more times our salary, and likely not working nearly as hard.
10. We keep a poker face when we read news blurbs about Senators who have absolutely NO idea what we do.

The list GOES ON.

So, yes, we nurses put up with a whole lot of nonsense. We nurses DO manage caseloads that years ago would have been unfathomable. We DO put on a poker face.

But we don’t “play cards.” We are playing the game to care for patients, save their lives, and make their lives better. Senator Walsh, it’s about time that you not only admit what you said was incorrect, not only vow to “follow a nurse,” but to use your government powers to make nurses’ lives BETTER.

Signed,

EVERY NURSE