Musical selection: Piano Concerto #5 in Eb, Op. 73, "Emperor," Allegro, Ludwig van Beethoven, courtesy of Classical MIDI Archives, © 2000 Pierre R. Schwob

NOTES FROM THE TRENCHES: WHAT THEY DON'T TEACH YOU IN NURSING SCHOOL

Since I started working as an LPN in April 1999, hundreds of you have e-mailed me, "Diana, what's it like to be a REAL nurse?"

OK, so maybe not hundreds. All right, not even one, for that matter. But still I feel compelled to write this section just in case any of you DO decide to ask me, "Diana, what's it like to be a REAL nurse?"

First of all, I rarely feel like a REAL nurse. A real asshole in scrubs sometimes, but I suppose it's all part of being a novice nurse. And once in a great while, I actually surprise myself when a patient or family member asks me a question I can actually answer. And I've found out that the more I learn, the more I realize I don't know jack shit. I can say that I know 20 times more about nursing now than when I started. But 20 times 0 is still 0!

Nursing school has never taught anyone how to be a nurse. It can teach you how nurses think, what they do, and how and why they do it, but the only way to learn how to be a nurse is to be a nurse. If you can graduate from nursing school with the knowledge that perhaps at least 75% of what you've just learned is complete bullshit with absolutely no relevance to the REAL nursing world, you've won half the battle.

But FWIW:

• There are three words every nurse MUST know: "Sorry, I can't." Repeat them slowly out loud several times: "Sorry, I can't." You'll need it when your scheduling coordinator asks you to work a double on your day off. Also, do NOT answer the phone on your day off. And above all, NEVER give them your cell phone number.

• If a cop pulls you over, just tell him/her that you're a nurse coming home from the shift from hell. Both cops and nurses know that there's a full moon out every night.

• Algebra is the most useless academic subject ever invented.

• Nursing is a profession that completely ignores the bagel and concentrates solely on the hole. If you have to do 1000 tasks, the one minor thing you do wrong will completely obliterate the 999 major things you do superbly.

• When in doubt, do it the hard way.

• Nursing. Like the Army, it's not a job. It's an adventure.

• There are several topics you should never discuss with patients: sex, religion, and politics, for example. And baseball.

• Nurses can out-belch, out-cuss, out-eat, and out-fart any beer-swilling truck driver or longshoreman around. If you don't now, you will.

• The nursing theories they teach you are just that -- theory. In other words, pure, unadulterated, academic bullshit. Orem, Roy, Rogers, Peplau et al. never had 4 family members dogging them, a patient c/o chest pains, another one falling, 2 CNAs arguing, a third calling out sick, 6 call bells ringing, a doctor on the phone, and the fire alarm going off -- all at once!

• Over the course of your nursing career, your immune system will become impervious to just about every disease that comes down the pike, including bubonic plague. However, it will remain powerless against the common cold.

• I am convinced that a patient would benefit more from a good, uninterrupted night's sleep than to be woken Q4H or Q6H to shove a damn pill or nebulizer in their face! I'm just as convinced that an occasional drink, joint, or lay would do them more good than most of the meds they're taking.

• Don't think of them as chocolates. Think of them as "energy pellets."

• Work always expands to fill the time you have to do it. Time doesn't expand to accommodate the work you have to do.

• Do nurses stab each other in the back? HELL, YES! Absolutely. And I've got the scars to prove it. But you know what? So do lawyers, teachers, secretaries, hair stylists, bus drivers, executives, architects, doctors, infotechies, electricians, and just about anyone who feels that they have to make others look bad so they can look good. Besides I've met more than enough good, caring nurses to make up for the creeps.

• The less time you have to complete your med pass, the more diabetics you will have, and the more they will need insulin coverage. Also, you will always have one less insulin syringe than diabetics who need insulin.

• As soon as you get ready to hang an IV, take a blood sugar, or do a treatment, the patient's phone will ring. Happens every time.

• The fastest way to cure a patient's bout of diarrhea is to have the doctor order a stool sample. Better than Lomotil -- works like a charm! While we're on the subject, there's no such thing as normal bowel movements. They're either consitipated or they have the trots.

• Forget everything you learn in nutrition. Nurses and other health care workers have notoriously lousy eating habits. The hours are shitty, the work can be stressful, and there's always someone bringing in donuts, bagels, cookies, chocolates, and other highly concentrated sources of refined carbs. If you want to get rich, just open a pizzeria or a Chinese take-out place near a health-care facility. Take it from someone whose dinner often consists of a Diet Pepsi and several packs of graham crackers on top of a med cart.

• While we're on the subject of food, 7-3 gets all the goodies, 3-11 gets the leftovers, and 11-7 gets to clean up the crumbs.

• Never say the word "quiet" in a health care facility. NEVER.

• Alot of patients seem to think that a hospital or SNF is a country club or a luxury hotel like the Waldorf-Astoria and that we're maids and room service. And then they get pissed when they can't get a hot pastrami on rye or a pepperoni pizza at 4 am. The difference is that at the Waldorf you get better food and service -- and it costs a lot less. I'm a nurse, not a maid, waitress, electrician, bartender, or concierge. I can get you a blanket, pain meds, or a cup of tea, or take you to the bathroom. I can't fix your phone line, bring you caviar and champagne, or get you tickets to opening day at Yankee Stadium (and if I could, I'd be using them myself).

• It's easier to achieve lasting peace between the Israelis and the Palestinians than it is to get two roommate patients to stop arguing about the TV, the room temperature, visitors, and especially the bathroom.

• Health care sucks. You're overworked, understaffed, underpaid, kicked in the ass, and screwed, glued, and tattooed from one end of the state to the other. But then, so does every other workplace, where the ethic is to screw the employees and drain the most amount of work out of them for the least amount of money. And then employers wonder whatever happened to employee loyalty. Well, if you want us to be loyal to you, be loyal to us instead of screwing us around.

• Pockets are a nurse's best friend. Check your pockets before you leave work. Trust me on this.

• Never trust anyone who says, "Trust me." Not even me. Especially not me.

• The only reward you get for doing your work is more work. This holds just as true for every other occupation as it does for nursing.

• When a patient or a family member asks you a question, they don't always want to hear the right answer. While we're on the subject of families, alot of them seem to think that the nursing personnel are underfed and too skinny so they ply us with cookies, chocolates, and other things to eat. ("Jeez, look at those poor people. Doesn't this place pay them enough to buy M & Ms?")

• When you're new to your job, and your supervisor tells you that the floor you've been assigned to "is a good place to learn," be afraid. Be VERY afraid... Also, if the nurse on the previous shift who you're relieving is REALLY happy to see you.

• You think nurses are underpaid and overworked? Try being a certified nursing assistant (and those of you with CNA experience can readily attest to this!) So treat your CNAs WELL. They're your eyes and ears. Thank them when they do something you ask them to do. If they tell you a patient is having a problem, take them seriously and follow it up stat. Praise them for a job well done. Help them out with repositioning a patient if they ask you. Put a patient on the bedpan if your CNAs are busy. Don't ask your CNAs to do anything you wouldn't do yourself. A good CNA who will work with you is a treasure.

• Your patients are your best teachers. Someone who's lived with a chronic condition for a long time (like diabetes, emphysema, a colostomy) knows way the hell more about their condition than you do. It's embarrassing to you but over time, these patients have figured out what works best for them, so learn from them.

• Be good to yourself because no one else will.

• Smile. Smile often. It makes people wonder just what the hell you've been up to.